Volume 23 - Issue 11 - November 2011

The Impact of Iso-Osmolar Contrast Use in Emergent Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Yumiko Kanei, MD, Kengo Ayabe, MD, Justin Ratcliffe, MD, Lori Vales, MD, Navin Nakra, MD, Patricia Friedman, MS, John Fox, MD

Abstract: The incidence of contrast-induced nephropathy (CIN) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was previously reported to be as high as 19%. Iso-osmolar contrast has frequently been used for populations at high risk for CIN, but a recent meta-analysis did not show a significant benefit of using iso-osmolar contrast in preventing CIN....

Preventing Contrast-Induced Nephropathy in Patients Undergoing Primary PCI

Shea Hogan, MD and Hitinder S. Gurm, MD

Contrast-induced nephropathy (CIN) continues to be one of the most common major adverse side effect of cardiac catheterization, and is associated with short- and long-term morbidity and mortality.1,2 This is particularly true in the population presenting with acute ST-elevation myocardial infarction (STEMI). A recent study evaluating the epidemiology of CIN in over 8000 patients undergoing PCI found that CIN occurred in 12% of STEMI, which was significantly higher compared with patients undergoing non-emergent catheterization (9.2% in unstable angina and NSTEMI patients and 4.5% undergoing elective PCI)....

Comparison of the Resource Utilization Between Simultaneous Strategy and Staged Strategy to Treat Two-Vessel Coronary Artery Disease by Percutaneous Coronary Intervention

Kenichi Sakakura, MD, Junya Ako, MD, Hiroshi Wada, MD, Norifumi Kubo, MD, Shin-ichi Momomura, MD

Abstract: Objectives. The purpose of this study was to compare medical resource use, such as total device cost, total contrast volume, and total fluoroscopy time between the staged and simultaneous strategies for treating two-vessel disease (2VD) by percutaneous coronary intervention (PCI). Background. 2VD can be treated by the staged strategy or the simultaneous strategy. Compared to the staged strategy, the simultaneous strategy may reduce medical resource use....

Dual-Source CT Angiography for Detection and Quantification of In-Stent Restenosis in the Left Main Coronary Artery: Comparison with Intracoronary Ultrasound and Coronary Angiography

Josef Veselka, MD, Pavla Cadova, MD, Pavol Tomasov, MD, Adla Theodor, MD, David Zemanek, MD

Abstract: Objectives. The aim of this study was to evaluate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) compared to coronary angiography (CAG) and intravascular ultrasound (IVUS) for detection and quantification of in-stent restenosis after left main (LM) coronary artery stenting. Materials and Methods. Fifty-one patients with percutaneous coronary intervention of the LM were prospectively evaluated....

Stent Evaluation by Coronary Computed Tomographic Angiography and Expert Consensus Documents

Harvey S. Hecht, MD

As coronary computed tomographic angiography (CCTA) has rapidly evolved, its extension to more complex scenarios has kept pace. Stent evaluation has intrinsic technical difficulties. However, since left main disease, in particular, is not reliably addressed by myocardial perfusion imaging, the potential importance of alternate technologies such as CCTA is increased. The paper by Veselka et al in the current issue of the Journal of Invasive Cardiology1 evaluated the accuracy of CCTA to detect left main in-stent restenosis (ISR) in 34 patients, 3 (8.8%) with intravascular-ultrasound documented ISR....

A High Dose of Adenosine to Induce Transient Asystole for Valvuloplasty in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): Is it a Valid Alternative to Rapid Pacing? A Prospective Pilot Study

Giedrius Davidavicius, MD1,2, Alaide Chieffo, MD1, Joanne Shannon, MD1, Francesco Arioli, MD1, Alfonso Ielasi, MD1, Marco Mussardo, MD1, Kensuke Takagi, MD1, Francesco Maisano, MD1, Mateo Montorfano, MD1, Cosmo Godino, MD1, Azeem Latib, MD1, Antonio Colombo, MD, PhD1,3

Abstract: Background. Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine....

Utility of Adenosine Sequelae in Primer Balloon Aortic Valvuloplasty

Abhishek Deshmukh, MD and Rajesh Sachdeva, MD

Aortic stenosis is an insidious disease with a long latency period.1 Severe symptomatic aortic stenosis is associated with poor outcomes unless an aortic valve replacement procedure is performed.1 In the real world, 30% of patients with severe symptomatic aortic stenosis do not undergo surgical aortic valve replacement because of advanced age, left ventricular dysfunction, or the presence of multiple comorbid conditions.2...

Simultaneous Inflation of Two Drug-Eluting Balloons for the Treatment of Coronary Bifurcation Restenosis: A Concept Series

Gregory A. Sgueglia, MD, PhD, Daniel Todaro, MD, PhD, Antonino Stipo, MD, Edoardo Pucci, MD

Abstract: Coronary bifurcation restenoses are especially challenging lesions to treat. In this report, four cases are described in which an innovative approach consisting of the simultaneous inflation of two drug-eluting balloons has been successfully applied to treat different kinds of bifurcation restenoses following both provisional and complex stenting strategies. These selected cases illustrate the concept and the advantages of a kissing drug-eluting balloon strategy for the treatment of virtually any kind of bifurcation restenosis....

Transradial Percutaneous Coronary Intervention in Patients Requiring Circulatory Assist Devices

Vineet K. Dandekar, MD and Adhir R. Shroff, MD, MPH

Transradial access for diagnostic and interventional procedures has been gaining acceptance in the United States.1 Advantages of transradial percutaneous coronary intervention (PCI) include improved patient satisfaction and potential decrease in costs related to early discharge.2-4 Perhaps the greatest advantage of this access strategy is a decrease in vascular complications.1,3-6...

Use of Embolic Capture Angioplasty for the Treatment of Occluded Superficial Femoral Artery Segments

Ahmad Zankar, MD, Emmanouil Brilakis, MD, Subhash Banerjee, MD

Abstract: Treatment of peripheral chronic total occlusion (CTO) is one of the most challenging lesion subsets in peripheral revascularization. Advanced wire technology, novel re-entry catheters and imaging techniques help in crossing such lesions. Subintimal dissection using blunt microdissection devices along with true lumen re-entry techniques have added to the success rates of treating peripheral CTOs....

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