Volume 22 - Issue 3 - March, 2010

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...

The Importance of Atrial Pacing during Alcohol Septal Ablation

John M. Buergler, MD and Sherif F. Nagueh, MD

Case description. A 52-year-old female presented to us with shortness of breath with her daily activities despite optimal medical therapy. An echocardiogram revealed hypertrophic cardiomyopathy with severe dynamic outflow tract obstruction. She was given the options of myectomy and alcohol septal ablation and she chose the latter. On catheterization, a pigtail at the LV apex and a catheter in the aorta revealed a gradient of 235 mmHg (Figure 1, note 400 scale) and a systolic blood pressure of 85 mmHg. As alcohol septal ablation can be complicated by complete heart block, a backup tempo...

Incomplete and Inappropriate Coronary Bifurcation Classification

Mohammad Reza Movahed, MD, PhD, FSCAI, FACC, FACP

Re: Provisional vs. Complex Stenting Strategy for Coronary Bifurcation Lesions: Meta-Analysis of Randomized Trials

The use of incomplete and inappropriate Medina coronary bifurcation classification has led to major flaws in randomized clinical trials of coronary bifurcation interventions

Dear Editor:
With great interest we read the recently published manuscript entitled: “Provisional vs. complex stenting strategy for coronary bifurcation lesions: meta-analysis of randomized trials.”1 In this meta-analysis, the authors concluded that provisional stenting is a...

ST-segment Elevation Myocardial Infarction in Severe Coronary Artery Stenosis: A Case Series

Mayank Agrawal, MD, Barry Uretsky, MD, Rajesh Sachdeva, MD

ABSTRACT: Recently, it has been reported that acute ST-segment elevation myocardial infarction (STEMI) frequently develops at the site of severe stenosis. This impression was derived from the observation of stenosis severity after aspiration of the thrombus leading to the event. In the past, STEMI was considered as a thrombotic event on a non-flow limiting coronary plaque mainly. We report a case series of patients who developed STEMI within hours to days of initial angiography, all of whom demonstrated severe flow limiting coronary artery stenosis.



The Impella 2.5 L for Percutaneous Mechanical Circulatory Support in Severe Humoral Allograft Rejection

Anna T. Beyer, MD, Peter Y. Hui, MD, Ernest Haeusslein, MD

ABSTRACT: Heart transplant recipients who experience humoral rejection are at risk for hemodynamic instability. We report a case of a 64-year-old male with cardiogenic shock due to allograft rejection requiring mechanical support while undergoing intense immunosuppression. He underwent implantation of a micro-axial endovascular pump (Impella). To our knowledge, this is the first reported case of successful Impella device deployment as a bridge-to-recovery strategy.


Acute allograft rejection is associated with increased morbidity and mortality i...

Left Ventricular Pseudoaneurysm Found after Mitral Valve Replacement Performed 30 Years Earlier

Elena Castilla, MD, Manuel Gato, MD*, José Ramón Ruiz, MD

ABSTRACT: Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier.


Case Report. Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery....

Efficacy and Safety of Bivalirudin in Patients with Diabetes Mellitus (Full title below)

Luke K. Kim, MD, S. Chiu Wong, MD, Robert M. Minutello, MD, Geoffrey Bergman, MD,
Dmitriy N. Feldman, MD

Efficacy and Safety of Bivalirudin in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in Current Clinical Practice

ABSTRACT: Objectives. This study sought to evaluate the short- and long-term efficacy and safety of bivalirudin in diabetic patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. Background. Early trials of platelet glycoprotein (GP) IIb/IIIa inhibitors have suggested a survival benefit in diabetic patients undergoing PCI. More recently, randomized trials have demonstrated that diabetic patients hav...

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