Volume 15 - Issue 6 - June, 2003

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 ...

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...

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