Volume 15 - Issue 6 - June, 2003

Debulking for In-Stent Restenosis in the Brachytherapy Era: Does it Still Have a Role?

Ajay Tuli, MD, †Veerappan Subramaniyam, MD, Stephen Bakir, MD, Peter C. Block, MD,
*Ian R. Crocker, MD, Christopher U. Cates, MD

Key words: angioplasty, brachytherapy, laser, restenosis

Trials comparing coronary artery stenting to coronary artery bypass grafting (CABG) have shown that repeat revascularization continues to be the main limitation of percutaneous intervention.1–3 Much of this repeat revascularization is related to in-stent restenosis, which itself is a particularly vexing problem with high recurrent restenosis rates.4

The most difficult in-stent stenoses to treat are diffuse lesions (> 10 mm).5 Balloon angioplasty (PTCA) alone of such lesions has resulted in poor ou...

Complete Sinus Inversus and Bicuspid Aortic Valve Stenosis

Deepak Bhakta, MD, Jeffrey A. Breall, MD, PhD, Vijay G. Kalaria, MD

Key words: adult congenital heart disease, angiography, bicuspid aortic valve stenosis, dextrocardia, situs inversus

Patients with congenital heart disease present interesting challenges during heart catheterization. We present an adult patient with complete situs inversus with congenital bicuspid aortic valve stenosis, a hitherto unreported association, and offer technical tips for performing left and right heart catheterization.

Case Report
A 60-year-old male presented with exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea and bilateral lower extremity edema. He also repor...

A Novel Use of Cutting Balloon in Treating Coronary Artery Dissection that Developed During Percutaneous Coronary Intervention

Shigenori Ito, MD, Shinsuke Ojio, MD, Takahiko Suzuki, MD

Key words: acute occlusion, bail-out, coronary angiography, coronary stent

Coronary dissections sometimes compromise distal flow due to lack of re-entry, or compression by hematoma after wire manipulation or balloon dilatation during percutaneous coronary intervention (PCI). Although such dissections might be managed successfully with stent implantation,1,2 in cases in which the dissection is excessively long, another option is to restore antegrade flow in the true lumen by creating re-entry to the dissection before the decision to deploy stents. Due to its unique structure, the ...

Transradial Management of Saphenous Vein Bypass Graft Disease Using Rheolytic Thrombectomy and Coronary Stenting

Tift Mann, MD, Jaffar Ali Raza, MD, C.H. Whitlock, RCIS, Michael Arrowood, PAC

Key words: bypass graft, distal protection, intervention

With the large number of patients who have had coronary bypass surgery in the past 20 years, management of recurrent ischemia in patients with venous bypass graft disease is a major challenge. Atherosclerotic disease in saphenous vein grafts (SVBG) is characterized by diffuse, friable, ulcerated plaques with a propensity for rupture and clot formation.1,2 Intervention in these diseased grafts is associated with significant periprocedural major adverse coronary events (MACE) due to embolization of this material.3–7...

Morphological and Functional Assessment of the Septal Course of a Left Coronary Artery Originating from the Right Sinus of Valsa

Thomas M. Schiele, MD, *Christof Weber, MD, Volker Klauss, MD

Key words: coronary anomaly, intracoronary pressure, intravascular ultrasound, multislice computed tomography

Origin of the left main coronary artery (LMCA) from the right aortic sinus is a rare coronary anomaly.1–11 When coursing interarterially, the risk of sudden death probably caused by myocardial ischemia due to compression of the LMCA between the great vessels during systole is significantly elevated.5,6,9,13–15 When coursing intraseptally, the clinical significance of this condition is not established. Exertional myocardial ischemia of clinical significance...

Cutting Balloon to Treat Carotid In-Stent Stenosis: Technical Note

Bernard R. Bendok, MD, *Gary S. Roubin, MD, **Barry T. Katzen, MD,
Alan S. Boulos, MD, Elad I. Levy, MD, *Thos Limpijankit, MD, Adnan I. Qureshi, MD, Lee R. Guterman, PhD, MD, L. Nelson Hopkins, MD

Key words: angioplasty, carotid stent, cutting balloon, in-stent stenosis

Carotid angioplasty with stenting for atherosclerotic stenosis is currently under examination in numerous trials as an alternative to carotid endarterectomy (CEA) and as an option for high-risk patients.1 In-stent stenosis is one of the possible long-term complications of vascular angioplasty and stenting. This condition is defined as >= 50% increase in the narrowing of the lumen within a stent, as compared with the diameter of the lumen immediately after treatment. The incidence of carotid in-stent stenosi...

Cutting Balloon Before Stent: Angiographic and IVUS Correlation

David G. Rizik, MD, Antoine M. Adem, MD, Neil C. Barman, MD

A 50-year-old male presented with de novo rest angina. The panel at the left demonstrates the angiographic and intravascular ultrasound (IVUS) appearance of the lesion pre-treatment. Following Cutting Balloon angioplasty with a 4.0 mm device, the center panel demonstrates the IVUS appearance showing remnants of the atherotome incisions, best seen at the 2 o’clock, 5 o’clock and 7 o’clock positions. The panel to the right demonstrates the final lesion appearance after implantation of a 5.0 NIR stent, requiring only 10 atmospheres to achieve full stent deployment. Lesion microsurgical inci...

Editor's Message - April 2003

Richard E. Shaw, PhD, FACC
Editor-in-Chief

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, case reports with brief reviews, and articles from the Journal special sections “Acute Coronary Syndromes”, “Interventional Pediatric Cardiology” and “Clinical Images”.

The first research article, by Dr. Dardas and colleagues from the Thessaloniki Heart Institute, St. Luke’s Hospital in Thessaloniki, Greece describes their novel approach to treating patients presenting with what appears to be bifurcation lesions, but are actually a false bifurcation of lesions in a main branc...

A Technique for Type 4a Coronary Bifurcation Lesions: Initial Results and 6-Month Clinical Evaluation

Petros S. Dardas, MD, Dimitris D. Tsikaderis, MD, Nick E. Mezilis, MD, Giannis Styliadis, MD

Percutaneous coronary intervention (PCI) of bifurcation lesions remains technically challenging.1,2 Immediate and mid-term results using balloon angioplasty are not always satisfactory for various reasons, such as low angiographic success rate (in the range of 75–85%), high complication rate (8–22%) and high restenosis rate (40–65%).3–5 Furthermore, first-generation stents such as the Palmaz-Schatz and Cook stents were not proven satisfactory in this clinical setting, as the small sidebranches were sacrificed in some cases or dilated with difficulty in others....

A New Technique for Coronary Bifurcations: Good News!

Antonio Colombo, MD and Vassilis Spanos, MD

Bifurcated coronary artery lesions represent one of the challenging areas in interventional cardiology. Coronary stenting resulted in more predictable results and higher angiographic success rate compared to balloon angioplasty. Angiographic restenosis rates nevertheless remain high, irrespectively of the different approaches employed.1–6

A limited number of studies are available in the literature regarding treatment of pseudo-bifurcation lesions.7 Traditionally bifurcated lesions have been classified according to the presence of disease in the main branch (MB), in b...

Editorial Staff
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