Volume 15 - Issue 11 - November, 2003

Oral Rapamycin in the Treatment of Diffuse Proliferative In-Stent Restenosis in a Patient with Small Reference Vessel

Alfredo E. Rodriguez, MD, PhD, Carlos Fernández Pereira, MD, Máximo Rodríguez Alemparte, MD

Case Report. A 63-year-old man was admitted to our hospital due to recent onset chest pain with radiation to the left arm, which was precipitated by minimum efforts and relieved by rest. He was evaluated at the coronary care unit and treated with aspirin, heparin and intravenous nitroglycerin. The electrocardiogram revealed a T-wave inversion in leads V4, V5, V6, D1, and AVL. His coronary risk factors were diabetes type II treated with an oral hypoglycemic agent, and dyslipedemia treated with statins. He was also a smoker.
Physical examination in the Coronary Care Unit was remarkabl
...

Percutaneous Repair of Coronary Artery Bypass Graft-Related Pseudoaneurysms Using Covered JOSTENTs

Jason H. Rogers, MD, *David Chang, MD, John M. Lasala, MD, PhD

Spontaneous rupture of a saphenous vein graft with pseudoaneurysm formation is a rare occurrence after coronary bypass grafting. Until now, pseudoaneurysm formation from a native coronary artery at the site of a left internal thoracic to radial artery T-graft anastomotic site has not been reported. Although the recommended treatment of vein graft or native coronary artery pseudoaneurysms remains poorly defined, open surgical ligation with placement of a new conduit, percutaneous coil embolization, and now treatment with covered stents are among the therapies reported. We hereby report the use ...

Pharmacoinvasive Management of Acute Coronary Syndrome in the Setting of Percutaneous Coronary Intervention: Evidence-Based, Sit

The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report

1Dean J. Kereiakes, MD, 2James Tcheng, MD, 3Edward T.A. Fry, MD, 4Deepak L. Bhatt, MD, 5Gideon Bosker, MD,
6Jose G. Diez, MD, 7James J. Ferguson, III, MD, 8Glenn N. Levine, MD, 9Gary L. Schaer, MD, 10James Zidar, MD

Over the past decade, impressive reductions in mortality, reinfarction and length of hospital stay have been reported in large-scale studies of patients with acute coronary syndrome (ACS). Despite these advances, substantial challenges remain in identifying the optimal combination of therapeutic agents [e.g., low molecular weight heparins (LMWHs) or unfractionated heparin (UFH), ADP receptor antagonists and glycoprotein (GP) IIb/IIIa inhibitors] that will maximize outcomes while minimizing drug-related adverse events in patients with ACS.
As a result of clinical trials published since the Mar...

Pharmacoinvasive Management of Acute Coronary Syndrome in the Setting of Percutaneous Coronary Intervention: Evidence-Based, Sit

The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report

1Dean J. Kereiakes, MD, 2James Tcheng, MD, 3Edward T.A. Fry, MD, 4Deepak L. Bhatt, MD, 5Gideon Bosker, MD,
6Jose G. Diez, MD, 7James J. Ferguson, III, MD, 8Glenn N. Levine, MD, 9Gary L. Schaer, MD, 10James Zidar, MD

Part II of III - Continued

TABLE 3 KEY (continued)
2) Unfractionated heparin(UFH) can be used as an alternative to enoxaparin. If UFH is used in the setting of PCI, activated clotting time (ACT) should be followed to achieve an appropriate level of anticoagulation. Use weight-based dosing according to guidelines. Weight-adjusted heparin dosing can be utilized during PCI. In those not treated with a GP IIb/IIIa inhibitor, 100 IU/kg IV should initially be administered; the target ACT is 300–350 seconds when measured by the Hemochron device. In those who are treated wit...

Complete Revascularization of Total Obstruction of Both Subclavian Arteries and Descending Abdominal Aorta by Combined Surgery

Jung-Sun Kim, MD, Donghoon Choi, MD, Kyung-Jong Yoo,* MD

The vast majority of symptomatic lesions of the aortic arch involve the subclavian artery.1 Since Bachman and Kim first reported a case of successful subclavian artery angioplasty in 1980,2 percutaneous transluminal angioplasty (PTA) has become a well established treatment modality for patients with atherosclerotic stenosis of subclavian artery.3 Chronic infrarenal aortic occlusion has a broad spectrum of ischemic manifestations, and aortofemoral bypass graft surgery has been considered as a gold standard in the treatment of aortoiliac artery occlusive disease. Total occlusion of both subclavi...

Pharmacoinvasive Management of Acute Coronary Syndrome in the Setting of Percutaneous Coronary Intervention: Evidence-Based, Sit

1Dean J. Kereiakes, MD, 2James Tcheng, MD, 3Edward T.A. Fry, MD, 4Deepak L. Bhatt, MD, 5Gideon Bosker, MD,
6Jose G. Diez, MD, 7James J. Ferguson, III, MD, 8Glenn N. Levine, MD, 9Gary L. Schaer, MD, 10James Zidar, MD

The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report

A total of 5,225 patients were enrolled in the PARAGON B trial. Among these patients, the type of heparin used was known in 5,200 (99.5%). The median duration of therapy was 72.8 hours for UFH and 79.7 hours for LMWH. LMWH was used in about one-fifth of the study cohort. Of the 389 sites that participated, approximately 61% of the sites used UFH only, 10% used LMWH only, and 28% used either UFH or LMWH (at the discretion of the attending physician). Enoxaparin was used in 91% of the patients treated with LMWH.36 In the PARAGON B trial, use of the LMWH enoxaparin in conjunction with a GP IIb/II...

Preservation of Myocardial Microcirculation During Mechanical Reperfusion for Myocardial Ischemia with Either Abciximab or Eptif

George Stoupakis, James Orlando, Harmit Kalia, Joan Skurnick, Muhamed Saric, Rohit Arora

Although rapid restoration of coronary flow in an infarct related artery is associated with improved survival, it is becoming increasingly evident that myocardial perfusion, and not just epicardial flow, is vital to myocardial salvage and viability. For example, patients with TIMI 2 flow are found to have a higher mortality than those with TIMI 3 flow, possibly as a result of impaired microcirculation.1 Myocardial blush grade (MBG) is an angiographic method of assessing myocardial microcirculation and provides independent risk stratification among patients with normal epicardial TIMI 3 flow. ...

Pulmonary Arteriovenous Fistula Discovered After Percutaneous Patent Foramen Ovale Closure in a 27-Year-Old Woman

Jeffrey M. Schussler, MD, Sabrina D. Phillips, MD, Azam Anwar, MD

Patent foramen ovale (PFO) is a common condition with an incidence as high as 25% in the general population.1 In some studies, young patients who present with neurological events show a higher prevalence of PFO and an association with a significant increase in recurrent events.2–4
Over the last few years, there has been a great deal of interest in the percutaneous management of PFO. Recent studies have demonstrated that percutaneous closure is both safe and successful in the treatment of PFO, as well as other intracardiac communications.5–10
Sporadic pulmonary arteriovenous malformation ...

Microcirculatory Effects of Abciximab and Eptifibatide: A Critical Appraisal

Dean J. Kereiakes, MD

The coronary microcirculation is critically important in the maintenance of myocardial nutritive blood flow. Even in situations where measures of epicardial blood flow appear normal, abnormalities in microcirculatory integrity secondary to microvascular occlusion may precipitate myocardial infarction and regional myocardial dysfunction. Atherothrombotic embolization of the distal microcirculation may occur spontaneously following plaque rupture during acute coronary syndromes or may occur secondary to percutaneous coronary intervention (PCI) induced plaque disruption. The debris produced by co...

Multiple Ulcerations in Plaque Behind Stent Struts Resulting in Late Stent Malapposition After Gamma Brachytherapy for In-Stent

Makoto Hirose, MD, Yoshio Kobayashi, MD, Jeffrey W. Moses, MD

Intracoronary stents reduce restenosis compared with conventional balloon angioplasty.1,2 However, in-stent restenosis remains an important clinical problem.3,4 Recently, randomized trials have demonstrated that intracoronary vascular brachytherapy (VBT) reduces recurrence after the treatment of in-stent restenosis.5–7 On the other hand, undesired effects of VBT such as late thrombosis and edge effect are also reported.6–8 Late stent malapposition is one of undesired effects of VBT. This case report describes multiple late stent malappositions after gamma VBT.

Case Report. A ...

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