Volume 22 - Issue 3 - March, 2010

Right Coronary Artery Anatomical Variants: Where and How?

Pallavi Solanki, MD, Christine Gerula, MD, Preet Randhawa, MD, Michael Benz, MD, James Maher, MD, Bunyad Haider, MD, Marc Klapholz, MD, Jack Palmaro, MA, MPH, Diane Alfano, RN, Edo Kaluski, MD

ABSTRACT: Background. Ectopic origin of the right coronary artery (RCA) occurs in ≈1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization. Methods. Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. “Ectopic RCA” was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus. Results. The study population included 2,120 patients, of wh...

Coarctation of Distal Thoracic Aorta — The Middle Aortic Syndrome in an Elderly Female with Severe Coronary Artery Disease

Sandhya Kommana, MD, Siddharth A. Wartak, MD, MRCP, John Joelson, MD, FACC

ABSTRACT: Coarctation of the distal aorta or middle aortic syndrome is a segmental stenosis of the middle portion of the aorta, between the arch and the terminal bifurcation. Middle aortic syndrome is a rare disease of infants and young adults presenting with hypertension, lower limb claudication and renal insufficiency and is diagnosed by aortography or magnetic resonance angiography.
Our case is unique because this condition was an incidental finding diagnosed during cardiac catheterization in a 70-year-old patient with hypertension in the absence of lower limb claudication. Recognit...

Clinical Utility of B-Type Natriuretic Peptide (Full Title Below)

Joshua M. Stolker, MD and ‡Michael W. Rich, MD

ABSTRACT: Background. B-type natriuretic peptide (BNP) and echocardiographic tissue Doppler indices (TDI) predict elevated filling pressures, but few data exist comparing these methods while adjusting for clinical variables. We hypothesized that BNP would provide incremental value for estimating left ventricular end-diastolic pressure (LVEDP). Methods. Clinical data, echocardiograms, and BNP levels were obtained in 182 geriatric patients undergoing diagnostic left-heart catheterization. Patients with severe valvular disease or acute myocardial infarction were excluded. LVEDP and standard echoc...

Evaluation of Balloon Withdrawal Forces (Full Title Below)

Marvee Turk, Vishal Gupta, MD, MPH, Tim A. Fischell, MD

Evaluation of Balloon Withdrawal Forces with Bare-Metal Stents, Compared with Taxus™ and Cypher™ Drug-Eluting Coronary Stents: Balloon, Stent and Polymer Interactions

ABSTRACT: Background. There have been reports of serious complications related to difficulty removing the deflated Taxus™ stent delivery balloon after stent deployment. The purpose of this study was to determine whether the Taxus SIBS polymer was “sticky” and associated with an increase in the force required to remove the stent delivery balloon after stent deployment, using a quantitative, ex-viv...

The Sticky Story of Stuck Stents

James C. Blankenship, MD and Catriona O. Kerr-Wilson*

We now know what was long suspected. In fact, interventionists suspected it for years, dating back to 2004 when the Food and Drug Administration first investigated Boston Scientific’s TAXUS drug eluting stent for “stickiness of the balloon during withdrawal.”1,2 But nothing was ever proven. Until now.

In this issue of the Journal, Turk et al report their tests on several stent/balloon delivery systems to determine whether the TAXUS stent delivery balloon is more difficult to withdraw after stent deployment than other stent balloons.3 Their ex vivo setup included silastic tubes in a he...

Restenosis Rates following Vertebral Artery Origin Stenting: Does Stent Type Make a Difference?

Christopher S. Ogilvy, MD,a,b,d Xinyu Yang, MD, PhD,a,e Sabareesh K. Natarajan, MD, MS,b,d
Erik F. Hauck, MD, PhD,b,d Luona Sun, BS,b,c Laura Lewis-Mason, MS, ANP-C,b,d L. Nelson Hopkins, MD,b,c,d
Adnan H. Siddiqui, MD, PhD,b,c,d Elad I. Levy, MDb,c,d

ABSTRACT: Objectives. To compare our experience with sirolimus- and paclitaxel-eluting stents (drug-eluting stents [DES]) and non-drug-eluting stents (NDES) for treatment of vertebral artery (VA) origin stenosis and review the literature. Methods. A retrospective review of our prospectively collected database was performed. Clinical and radiologic follow up was obtained by reviewing office records and radiology. Data collected included demographics, comorbidities, presenting symptoms, stenosis severity, contralateral VA stenosis and/or carotid stenosis, type of stent used, angioplasty before o...

The Twin-Pass Dual Access Catheter for Assessment of the No-Reflow Phenomenon

David Meerkin, MBBS, Jonathan Balkin, MBBCH, Joseph Shaheen, MD, Dan Tzivoni, MD

ABSTRACT: The absence of antegrade flow in a coronary artery during an intervention is an ominous finding requiring diagnosis of the underlying cause and rapid treatment to limit myocardial necrosis. The Twin-Pass dual access catheter allows for distal coronary contrast injection without loss of wire position. The aim of this analysis was to determine the opacification and flow features of patients with abrupt arrest of antegrade flow to determine the underlying pathology. Methods. Coronary angiograms of patients with abrupt arrest of antegrade flow during an intervention that underwent distal...

Initial Experience of Removal of 10-French Sheaths Using the 8-French Angio-Seal Vascular Closure Device

Arzhang Fallahi, MD and Michael Kim, MD

ABSTRACT: Objectives. We studied the use of 8 Fr Angio-Seal in closure of access sites up to 10 Fr. Background. The use of larger French catheters for procedures such as valvuloplasty and percutaneous valve replacement has required the use of better methods for arterial closure. The use of 6 and 8 Fr Angio-Seal hemostatic devices (St. Jude Medical, St. Paul, Minnesota) has been well described and are routinely used for diagnostic and interventional procedures up to 8 Fr in size. However, no data are available for the use of an 8 Fr Angio-Seal device in the closure of access sites up to 10 Fr. ...

The Relationship Between Bleeding and Adverse Outcomes in ACS and PCI: Pharmacologic and Nonpharmacologic Modification of Risk

Steven V. Manoukian, MD

ABSTRACT: Antithrombotic therapy, including antiplatelet and antithrombin agents, effectively reduces the risk of ischemic events in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI). Unfortunately, these agents intrinsically increase the risk of bleeding complications, which in turn are associated with adverse outcomes, particularly mortality. Accordingly, there is great value in improving the understanding of bleeding complications, including the definitions employed, severity and types of bleeding, as well as the patient characteristi...

Transcatheter Coil Embolization of Multiple Bilateral Congenital Coronary Artery Fistulae

Juan F. Iglesias, MD, Hoa Tran Thai, MD, Tito Kabir, MD, Christan Roguelov, MD, Eric Eeckhout, MD

ABSTRACT: Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but remain a relatively uncommon clinical problem. Moreover, multiple fistulae originating from both the left and the right coronary arteries and draining into the left ventricular chamber are a rare condition. Due to the low prevalence of these anomalies, the appropriate management of patients with symptomatic coronary artery fistulae is controversial.

Transcatheter closure approaches have emerged as a less invasive strategy and are nowadays considered a valuable alternative to sur...

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