Volume 23 - Issue 3 - March, 2011
Editor's Message
- Mon, 2/28/11 - 5:36pm
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The goal of the Journal of Invasive Cardiology is to provide state-of-the-art information that will support clinicians in the effective diagnosis and treatment of patients with cardiovascular disease. There are many selections in this issue that I hope readers will find useful in their clinical practice.
Kounis Syndrome Is the Likely Culprit in Devastating Stent Thrombosis
- Mon, 2/28/11 - 6:06pm
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Dear Editor:
Blich et al1 reported for the first time as high as a 4.4% incidence of stent thrombosis in consecutive real-world, high-risk patients receiving a drug-eluting stent during a median follow-up period of 22 months, but they did not refer to the hypersensitivity inflammation occurring inside the stented coronary arteries.
The Transradial Approach is Associated with Lower Risk of Adverse Outcomes Following Percutaneous Coronary Intervention: A Single-Center Experience
- Mon, 2/28/11 - 6:48pm
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ABSTRACT: Objective. We sought to test the hypothesis that the transradial approach is associated with lower risk of adverse outcomes following percutaneous coronary intervention (PCI) compared to the transfemoral approach, and to examine whether the adoption of the transradial approach could result in improved quality of care for PCI in a single-center practice. Background. Although previous research has suggested that the transradial approach is associated with lower risk of adverse outcomes following PCI, it is not widely used in the United States.
The Rising Tide of Transradial Cardiac Catheterization: Riding the Wave
- Mon, 2/28/11 - 7:44pm
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A sea change begins with ripples becoming waves and finally the rising tide heralds a new environment, often a transformation of dramatic proportions. So it appears with the re-introduction of the transradial catheterization approach. While lately there are some new aspects of the technique (e.g., small needles, wires, sheaths and catheters), the transradial approach was known and used widely for the last decade outside the United States. What is it now that brings this rising tide of transradial activity to our shores? The answer is outcome data.
Feasibility and Safety of Elective Transradial Coronary Intervention in Asian Females
- Mon, 2/28/11 - 9:09pm
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ABSTRACT: Background. Transradial access for angioplasty and percutaneous intervention (PCI) has become more popular across the world due to lower risk of bleeding and better patient comfort. It has been shown to be effective and feasible in the Western population. However, there is a relative paucity of similar data for small-statured females, especially from Asian countries. Given the increased theoretical risk of local complications due to smaller-sized radial arteries in such females, feasibility and safety of transradial PCI (rPCI) needs to be better established in this group.
Transradial PCI in Women: Problem Solved or Clinical Equipoise?
- Mon, 2/28/11 - 9:30pm
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Bleeding complications that occur after percutaneous coronary intervention (PCI) are associated with increased morbidity and mortality.1 Studies indicate that certain populations are at higher risk for bleeding: the elderly, patients with renal insufficiency and women.2 Female sex has been consistently identified as a risk factor for hemorrhagic complications in the setting of acute coronary syndrome (ACS),2 elective PCI3 and ST-segment elevation myocardial infarction.4
Use of Low-Dose Heparin with Bivalirudin for Ad-hoc Transradial Coronary Interventions: Experience from a Single Center
- Mon, 2/28/11 - 9:43pm
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ABSTRACT: Background. The majority of coronary angioplasty is done via the femoral artery, with vascular complications being a major adverse event. Bivalirudin has been shown to reduce bleeding complication and improve outcomes. The use of bivalirudin in radial interventions has largely been limited due to the routine use of heparin for the diagnostic procedure. In current practice there is a concern with using the traditional 5,000 Units of heparin during radial sheath insertion and administration of bivalirudin when proceeding to percutaneous coronary intervention (PCI).
Bivalirudin and Transradial Access – The End of the Bleeding Era for Catheterization Procedures?
- Mon, 2/28/11 - 11:41pm
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The most common complications of catheterization procedures are access-site bleeding and hematoma which occur in 2–10% of all procedures.1 Even after multivariable adjustment, numerous studies have shown periprocedural bleeding to be an independent predictor of morbidity and mortality.2 Bleeding endpoints used in most clinical trials combine both access site and internal organ-related bleeding. The importance of access-site bleeding was demonstrated by Doyle et al in over 17,000 patients.3
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