Volume 15 - Issue 6 - June, 2003

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...

Use of Platelet Glycoprotein IIb/IIIa Inhibitors and Spontaneous Pulmonary Hemorrhage

Arshad Ali, MBBS, MRCP, Mustafa Hashem, MD, Howard S. Rosman, MD, Ghassan Kazmouz, MD, Julius M. Gardin, MD, Theodore L. Schrieber, MD

Key words: percutaneous coronary intervention, platelet glycoprotein IIb/IIIa inhibitors, pulmonary hemorrhage

In 1983, the description of an antibody that blocked the platelet glycoprotein (GP) IIb/IIIa receptor led to the development of a chimeric monoclonal antibody called abciximab for treatment of patients undergoing high-risk percutaneous coronary intervention (PCI).1,2 The EPIC trial clearly demonstrated the clinical benefits of abciximab in these patients.3 Since then, multiple peptide and nonpeptide antagonists of the IIb/IIIa receptor have been developed....

Pulmonary Hemorrhage During Glycoprotein IIb/IIIa Inhibitor Therapy: An Uncommon but Life-Threatening (and Under-Recognized) Com

George Dangas, MD, PhD and Ioannis Iakovou, MD

The study presented by Ali et al. in this issue of the Journal reports an institutional experience with pulmonary hemorrhage in patients treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. Use of these intravenous agents has been shown to lower the peri-procedural myonecrosis in patients who undergo coronary angioplasty and stent placement.1–4 However, there are increased bleeding complications, most frequently at the vascular access site.3–5 These complications are certainly in excess to those observed with heparin or bivalirudin when given alone, and appear...

Arterial Wall Temperature Following Coronary Stent Implantation in Pigs: The Role of Post-Stent Inflammation

Leonidas Diamantopoulos, MD, PhD, Yanming Huang, MD, Xiaosun Liu, MD, Shenggiao Li, MD, Walter Desmet, MD, PhD, Frans Van de Werf, MD, PhD, Ivan De Scheerder, MD, PhD

Arterial endoprostheses (stents) are widely used to improve angioplasty outcome and successfully restore the reduced vascular lumen. However, the metallic nature of stents causes some degree of arterial wall inflammation. This inflammation is known from ex vivo studies,1,2 and has been cited as a possible contributory cause in restenosis following stent implantation3–5 as well as for increased local thrombogenicity.6–8 Yet, it has not been studied in vivo. Such an in vivo study of post-stent inflammation would yield important information regarding the estab...

Superficial Femoral Artery Occlusion: Nitinol Stents Achieve Flow and Reduce the Need for Medications Better than Balloon Angiop

Leslie Cho, MD, *Marco Roffi, MD, †Debabrata Mukherjee, MD, §Deepak L. Bhatt, MD, §Christopher Bajzer, MD, §Jay S. Yadav, MD

Key words:balloon angioplasty, SFA, stents

Stents have proven superior to balloon angioplasty in the treatment of coronary atherosclerosis in terms of reduction of acute complications and restenosis.1,2 However, in the treatment of superficial femoral artery (SFA) stenosis, multiple studies have shown equivalent patency between balloon angioplasty and stenting.3,4 Most of these studies used stainless steel stents, with minimal radial force and flexibility. To date, there has been no study assessing the efficacy of next generation stents compared to balloon angioplasty ...

SFA Intervention in the Treatment of Total Occlusions: Can Endovascular Therapy Compete with Surgical Bypass?

Frank J. Criado, MD

I read with interest the report by Cho et al. on the results of SFA intervention for treatment of occlusive (not stenotic) lesions. They compared the 6-month outcome of PTA alone with stenting using the Smart nitinol device. We are not told how many patients underwent an attempt at recanalization overall as only “successful cases” are being reported. This and other significant shortcomings limit the value of their experience,1 but it is refreshing to see that the authors acknowledged such shortcomings in the manuscript.

The subject of nonsurgical recanalization of SFA occlusi...

Severe Aortic Coarctation in Infants Less Than 3 Months: Successful Palliation by Balloon Angioplasty

*†P. Syamasundar Rao, MD, *Saadeh B. Jureidini, MD, *Ian C. Balfour, MD,
*Gautam K. Singh, MD, *Su-chiung Chen, MD

Key words: aortic coarctation, balloon angioplasty, infants, neonates, transcatheter management

Treatment of native aortic coarctation (AC) by balloon angioplasty (BA) is a controversial issue,1–6 but gradually the procedure is gaining acceptance in the management of children7–12 with native coarctation. However, it remains controversial in neonates and young infants.2,13,14 Because of the excellent results that we have been able to achieve with BA in neonatal and infant coarctations,13,15–19 we have utilized this technique as a first-line t...

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 ...

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