Volume 15 - Issue 1 - January, 2004

Multi-Lesion “Culotte” and “Crush” Bifurcation Stenting with Sirolimus-Eluting Stents: Long-Term Angiographic Outcome

Joost Daemen, Pedro A. Lemos, MD, Patrick W. Serruys, MD, PhD

Case Report. A 63-year-old man, an ex-smoker with a history of hypertension and previous myocardial infarction, was admitted with stable angina (Canadian Cardiovascular Society Class 1) for elective percutaneous coronary intervention. Pre-procedure coronary angiogram revealed diffuse disease in the proximal and mid segments of the left circumflex artery (LCx) that was totally occluded in its distal portion (Fig. 1A). The first obtuse marginal branch (OM) presented a severe ostial stenosis (Fig. 1A). Also, the left anterior descending artery (LAD) presented a long stenosis in its mid por...

Anomalous Origin of Left Internal Mammary Artery

Shahid Aziz, MBChB, MRCP, and David R. Ramsdale, MD, FRCP

Origin of the internal mammary artery from sites other than the inferior surface of the first part of the subclavian artery is not uncommon. We describe the case of a left internal mammary artery (LIMA) originating from the third part of the left subclavian artery and its clinical relevance.

Case Report. A 65-year-old man gave a two-week history of unstable angina seven years after successful coronary artery bypass (CABG) surgery. He had required two admissions to the hospital with typical angina at rest associated with ST segment depression in leads V4-V6, I and AVL and raised Tr...

Successful Treatment in a Case of Acute Aortic Dissection Complicated with Acute Myocardial Infarction Due to Occlusion of the L

Yoshikazu Ohara, MD, Yoshikazu Hiasa, MD, Shinobu Hosokawa, MD

Recently, the surgical results of acute aortic dissection (Stanford type A) have improved. However, the treatment of cases complicated with severe organ ischemia, especially myocardial ischemia, is very difficult. When the aortic dissection extends to the coronary artery, catastrophic changes in the hemodynamic state occur; as a result, it is often difficult to save the patient’s life in such cases.1 Most of the cases in which a fatal outcome is avoided are successful emergency operation cases or right coronary myocardial infarction cases.2–6 We reported a case successfully treated by perc...

Considerations on Radiation Source Selection and Utilization in Vascular Brachytherapy

Ian Crocker, MD

The initial evaluation of radiotherapy in animal models of restenosis focused on the used of 192Iridium ribbons, a commercially available source. After initial animal studies revealed that therapy with this isotope reliably inhibited vascular renarrowing following balloon angioplasty, investigation into alternative, more “user-friendly” radiation delivery sources and systems was undertaken. Permanently implanted radioactive stents were very successful in animal models and clinical trials at inhibiting neointimal proliferation within the stent but created problems of narrowing at the ends o...

The Anticoagulant Therapy with Bivalirudin to Assist in the Performance of Percutaneous Coronary Intervention in Patients with

Kenneth W. Mahaffey, MD,* Bruce E. Lewis, MD,† Nancy M. Wildermann, BA,* Scott D. Berkowitz, MD,*‡ Renee M. Oliverio, RN,* Mark A. Turco, MD,§ Yoseph Shalev, MD,§§ Peter Ver Lee, MD,*** Jay H. Traverse, MD,‡‡ A. Ralph Rodriguez, MD,** E. Magnus Ohman, MD,†† Robert A. Harrington, MD,* Robert M. Califf, MD,* for the ATBAT Investigators

Heparin-induced thrombocytopenia (HIT) is infrequent and often goes unrecognized. It occurs in ~1% to 5% of the patients given unfractionated heparin,1 about 25–50% of whom will develop HIT with thrombotic syndrome (HITTS).2 Morbidity and mortality are high, and more than 50% of patients suffering thrombotic complications will die.3 Patients with recognized HIT may require anticoagulation for acute coronary syndromes (ACS) or percutaneous coronary intervention (PCI), thus presenting a clinical challenge given the limited alternatives for anticoagulation treat...

Hemostasis in the Era of the Chronic Anticoagulated Patient

Bonnie Weiner, MD, *Thomas Fischer, PhD, †Sergio Waxman, MD

Mechanisms for Hemostasis and Comparative Efficacy

The technology to produce poly-N-acetylglucosamine (pGlcNAc) polymer is based on a biomaterial that is derived in a fiber form from aseptic cultures of a marine microalgae diatom. Once isolated and purified, the high quality, pure material is subject to rigorous quality control and quality assurance. The end product can be formulated as patches, lyophilized patches, gels, microspheres, and foams. The isolation of pGlcNAc fibers provides the source of the material for the manufacture of the Syvek Patch® (Marine Polymer Technologies, Danvers...

Use of Lepirudin During Percutaneous Vascular Interventions in Patients with Heparin-Induced Thrombocytopenia

Kevin Cochran, MD, Tony J. DeMartini, MD, Bruce E. Lewis, MD, James O’Brien, RN, Lowell H. Steen, MD, Eric D. Grassman, MD, PhD, Ferdinand Leya, MD

Percutaneous coronary intervention is a common procedure, with over 750,000 interventions performed in the United States per year. Balloon inflation and stent deployment cause endothelial injury and plaque disruption, leading to platelet activation, thrombin generation and an inflammatory response. Aspirin, clopidogrel, platelet glycoprotein (GP) IIb/IIIa receptor inhibitors and unfractionated or low-molecular weight heparin are routinely used to counteract the effects of thrombin and the stimulated platelet population. The GP IIb/IIIa inhibitors block the final common pathway of platelet acti...

Thrombolytic Therapy for Right Atrial and Pulmonary Embolus

David G. Rizik, MD, Bernard J. Villegas, MD, Andre P. Bouhasin, MD, Richard Levinson, MD

A 68-year-old male with a history of hypertension presented to the emergency department with acute onset pain and severe swelling of the left lower extremity. Pleuritic chest discomfort was also noted. He had been traveling by automobile from Canada to the Desert Southwest for 3 days and admitted to very little activity during this period. Physical exam was notable for a swollen, painful left calf with an easily reproducible Homan’s sign. He was noted to have a murmur of tricuspid regurgitation. Shortly after initial evaluation, he became visibly dyspneic with oxygen saturations of 89–90% ...

PCI Options in Heparin-Induced Thrombocytopenia

George Dangas, MD, PhD, and Eugenia Nikolsky, MD, PhD

Heparin-induced thrombocytopenia (HIT) is a rather rare complication of heparin therapy, but may occasionally lead to devastating or even life-threatening complications. HIT is more frequent after therapy with unfractionated than low molecular weight heparin. The inherent problem of prothrombosis in HIT can be a major obstacle in patients who need therapy with percutaneous coronary interventions (PCI), especially with stent implantation. This is due to the iatrogenic plaque disruption and promotion of an endovascular thrombosis process during PCI, and the added risk of stent thrombosis. Theref...

Treatment of In-Stent Restenosis in a Gastroepiploic Artery Coronary Bypass Graft with Brachytherapy

William B. Hillegass, MD, MPH, Gilbert J. Zoghbi, MD, Anand Pandey, MD, Vijay K. Misra, MD, Gregory D. Chapman, MD, Brigitta C. Brott, MD

Since it was first used in 1984 and reported in 1987,1,2 the right gastroepiploic artery (RGEA) has emerged as an effective third or isolated arterial conduit for complete arterial bypass grafting or for use in cases of limited graft numbers or poor quality vein for grafts.3–5 The RGEA can be used as a pedicled or free graft with or without cardiopulmonary bypass.6 The RGEA grafts are superior to vein grafts, with > 95% short-term patency rates and actuarial 5-year patency rates of 80–85%,7–9 with a 5-year survival rate > 92%.5,9 Ischemic events related to pedicled RGEA grafts result fro...

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Editorial Correspondence
  • Laurie Gustafson, Executive Editor, JIC
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