Volume 13 - Issue 11 - November, 2001
Stenting in Unusual Settings: Rotational Atherectomy of a Stent-Jailed Septal Perforator: A Good Verdict for the Prisoner
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Catheter-based techniques for revascularization offer a good solution to the vexing problem of stenosis in septal perforators, which are not accessible to surgical grafting, and which often are erroneously relegated as inconsequential. Stenosis of large septal perforators can cause angina, rhythm and conduction abnormalities, and ventricular septal ischemia.1,2 The latter could be particularly detrimental when there is ventricular dysfunction. Moreover, in situations of right coronary artery (RCA) occlusion, the septal perforators from the left anterior descending (LAD) branch are the principa
False Aneurysm and Mediastinal Hematoma: Complications of Simultaneous Transcatheter Therapy for Coarctation of the Aorta and Pa
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Coarctation of the aorta (CoA) is frequently associated with patent ductus arteriosus (PDA). Balloon angioplasty of CoA and coil treatment of PDA has been reported as an effective alternative to surgical therapy. However, simultaneous interventional catheterization therapy for CoA and PDA is not encouraged.1,2 We report the experience of a 4-month-old infant, with intractable congestive heart failure caused by CoA and PDA, who underwent both balloon angioplasty and coil occlusion during a single procedure. After balloon angioplasty, his heart failure dramatically resolved. An asymptomatic medi
Stenting in Unusual Settings: Stenting of the Septal Perforator Coronary Artery
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The interventricular septum (IVS), which is a common wall for the right and left ventricles, makes up about one-third of the total left ventricular mass and plays an important role in both right and left ventricular function.1 The major part of the IVS is supplied by septal perforator (SP) branches of the left anterior descending coronary artery (LAD). This report describes the first application of intracoronary stenting to the septal perforator coronary artery in a patient with a totally occluded LAD and a patent venous graft to the distal LAD.
Case Report. A 42-year-old male ad
Stenting in Unusual Settings: Compression of a Subintimal or False Lumen Stent by Stenting in the True Lumen
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Since stents were first approved in the United States for clinical use in the fourth quarter of 1993, their use has skyrocketed with 890,000 stents implanted in coronary arteries in 550,000 interventions in the United States in 1999.1 A variety of complications have been described in association with stent deployment, including coronary artery aneurysm,2–4 stent embolization,5 dissection,6 subacute thrombosis,7–9 sidebranch closure10 and in-stent restenosis.7,11 A rare complication of intravascular stenting, subintimal or false lumen deployment, has been reported in 2 patients undergoing p
Congenital Coarctation and Takayasu’s Arteritis: Aortic Stenting Employing Intravascular Ultrasound
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Case Report. A 23-year-old woman was admitted for evaluation and treatment of aortic coarctation. She was first noted to have a murmur in infancy but did well throughout her early childhood years and no intervention was recommended. She remained free of symptoms until her first pregnancy 6 years prior to the current admission. During the last trimester of her first pregnancy, she was noted to be hypertensive requiring medical treatment. Her pregnancy was brought to term without further problems, delivering a healthy baby girl. After her delivery and for the next 4 years she did not unde
"Side Balloon Stenting": A Novel Technique for Bifurcation Lesions
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Coronary angioplasty procedures involving bifurcations are still challenges with no easy solutions. Kissing wire and balloon techniques,1-2 directional and rotational atherectomy3-8 and excimer laser angioplasty9 have not resulted in satisfactory short- or long-term outcomes,10–12 and have a rate of complications that are still too elevated.13–16
The utilization of coronary stents, in order to obtain a better bifurcation coverage and a lesser recoil at the ostium site, is another reliable approach, but well-known risks are side branch occlusion,
Predictors of Mortality at 30 Days in High-Risk Patients Treated with Direct or Rescue Stenting for Acute Myocardial Infarction
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Large-scale trials reported the benefits of coronary angioplasty over systemic thrombolysis for the treatment of acute myocardial infarction (AMI).1,2 More recent studies demonstrated that stenting can determine a further improvement in results over conventional balloon angioplasty.3,4 However, most of these data were obtained in selected patients so that results achievable in a broader population, including patients with more severe conditions, may be expected to be less impressive. In fact, it is known that patients who are not eligible for randomized trials have an unfavorable combination o
Pre-Operative Intra-Aortic Balloon Counterpulsation in Stable Patients with Left Main Coronary Disease
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The use of intra-aortic balloon counterpulsation (IABC) to reduce left ventricular afterload and myocardial oxygen consumption is clearly indicated in patients with refractory myocardial ischemia or acute myocardial infarction complicated by cardiogenic shock.1–4 However, the ability of IABC to increase diastolic antegrade coronary blood flow through critically stenosed coronary arteries is not well substantiated.1,2,5–8 Therefore, the role of “prophylactic” IABC in hemodynamically stable patients with severe coronary artery disease undergoing surgical revascularization remains controv
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