Volume 15 - Issue 11 - November, 2003

Collateral Formation in Patients After Percutaneous Myocardial Revascularization: A Mechanism for Improvement?

Chi Hang Lee, MRCP, Pieter C. Smits, MD, Kengo Tanabe, MD, Ron T. van Domburg, PhD, Muzaffer Degertekin, MD, Wim van der Giessen, MD, Patrick W. Serruys, MD

Percutaneous myocardial revascularization (PMR) has emerged as a less invasive alternative to the transmyocardial revascularization (TMR), which requires thoracotomy. Initial results of PMR are encouraging with a significant proportion of patients that experience an increase in exercise capacity, reduction in angina frequency and improvement in quality of life.1,2 Although a recent double-blinded randomized clinical trial has cast doubt on the efficacy of PMR,3 the substantial improvements seen in other clinical trials are factual. The underlying mechanism accounting for the improvement seen a...

Metabolically Controlled Reperfusion in Acute Myocardial Infarction: Should the Polarizing Solution be Given Subselectively?

Paolo Angelini, MD, P. Clay Haas, DO, †Chiara Bucciarelli Ducci, MS, *Steven Adams, PhD, †Judy Ober, BS, †Joyce Bigley, BS, CCP, †Fred J. Clubb, DVM, PhD, †O.H. Frazier, MD

Acute myocardial infarction (AMI) is characterized by a progressive, irreversible loss of myocardium that results from sustained critical ischemia. Treatment involves recanalizing the occluded culprit coronary artery to restore blood flow, originally by means of systemic fibrinolysis2 and more recently with a catheter device.3 Unfortunately, reperfusion of the ischemic myocardium with blood can, itself, cause arrhythmias and further tissue injury.4 However, substantial laboratory and clinical evidence indicates that ischemic injury may be lessened by the systemic administration of glucose, ins...

Endocardial Electromechanical Mapping in a Porcine Acute Infarct and Reperfusion Model Evaluating the Extent of Myocardial Ische

Jacob Odenstedt, MD, Chrichan Månsson, Lab. Asst., Sven-Olof Jansson, MD, Lars Grip, MD, PhD

Catheter-based, left ventricular, electromechanical mapping (EMM) has evolved as a diagnostic tool to characterize ischemic and injured myocardium, and has the potential for direct myocardial interventions.1–15 It is difficult to identify the myocardium at risk and irreversible infarcted areas in the setting of acute myocardial infarction (AMI). Mapping has the potential of improving accuracy since preserved electrical myocardial activity indicates viable myocardium and reduced mechanical activity either can represent infarcted or ischemic myocardium.6 However, the criteria for diagnosis by ...

Improved In-Hospital Outcomes in Acute Coronary Syndromes (Unstable Angina/Non-ST Segment Elevation Myocardial Infarction) Despi

Francis Q. Almeda, MD, Robert C.Hendel, MD, Sandeep Nathan, MD, Peter M. Meyer, PhD, James E. Calvin, MD, Lloyd W. Klein, MD

The optimal approach to the management of acute coronary syndromes (ACS), including unstable angina (UA) and non-ST segment myocardial infarction (STEMI), continues to evolve. These patients comprise a heterogenous population with varying degrees of risk of death and recurrent cardiac ischemic events. Tailoring pharmacologic and interventional strategy based on to an individual’s specific risk profile provides the most benefit to patients with the greatest propensity for subsequent cardiovascular events, and conserves scarce economic and medical resources. Risk stratification using The Throm...

Vascular Brachytherapy and the Strontium90 Vascular Brachytherapy System

Mark Reisman, MD and William A. Gray, MD

Vascular brachytherapy, the delivery of a single dose of a radioactive isotope directly inside the target area of the coronary artery after balloon angioplasty, is the only clinically proven therapy and is the standard of care for patients with in-stent restenosis. Over the last several years, vascular brachytherapy has been widely studied with several multicenter, randomized trials, registries and many single center experiences with several different systems and isotopes. The Strontium90 vascular brachytherapy system (Beta-Cath™ System, Novoste Corporation, Norcross, Georgia), the first vas...

Benefits of Endovascular Hypothermia on Myocardial Preservation in the Setting of Cardiogenic Shock

David G. Rizik, MD, Bernard J. Villegas, MD, Andre Bouhasin, MD

Case Report. A 76-year-old female with carotid disease and a previous CVA presented in cardiogenic shock due to an inferior myocardial infarction (MI). Endovascular hypothermia was administered in the emergency room, reducing her body temperature from 98.6 ºF to 91.4 ºF. Attempted percutaneous revasculaization failed secondary to inability to pass a guidewire due to vessel tortuosity. Hypothermic conditions were maintained for three hours following transfer to the ICU. Following extubation on day three she had no residual neurologic deficits, despite protracted hypotension necessit...

Anomalous Coronary Artery Arising From the Opposite Sinus: Descriptive Features and Pathophysiologic Mechanisms, as Documented

Paolo Angelini, MD, José Antonio Velasco, MD, David Ott, MD, *G. Reza Khoshnevis, MD

Coronary anomalies continue to present an arcane puzzle to most cardiologists. We wish to focus on one particularly fascinating type of defect, in which both coronary arteries arise from the same aortic sinus, or an Anomalous Coronary Artery originates from the Opposite (than normal) Sinus (ACAOS). First reported in 1966 by Jokl and associates1 and more extensively discussed in 1974 by Cheitlin2 and Liberthson3 and their colleagues, anomalous origination of the left coronary artery (LCA) from the right aortic sinus is associated with a high risk of sudden death, usually related to strenuous ex...

Localized Bronchiectasis is a Definite Association of Coronaro-Bronchial Artery Fistula

Dr. Man-Hong Jim, Dr. Stephen Wai-luen Lee, Dr. Linda Lam

Vascular anastomoses between the coronary arteries and the bronchial arteries were found in 22% of normal subjects and in about 48% of patients with significant coronary artery disease (CAD).1 These vascular anastomoses are congenital in origin, usually small and hemodynamically insignificant. Sizable coronaro-bronchial artery fistula (CBF) is rare. It is described in the literature as individual case reports in about a dozen cases.1–14 Because of the limited number of documented cases, the pathophysiology, natural history and clinical presentation remain unclear. The factors governing the o...

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 ...

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