Volume 16 - Issue 3 - March, 2004

Percutaneous Coronary Interventions in Diabetic Patients: Is Complete Revascularization Important?

Eugenia Nikolsky, MD, PhD, Luis Gruberg, MD, Chandrashekhar V. Patil, MD, Ariel Roguin, MD,
Michael Kapeliovich, MD, Sirouch Petcherski, MD, Monther Boulos, MD, Ehud Grenadier, MD, Shlomo Amikam, MD, Shai Linn, MD, Walter Markiewicz, MD, Rafael Beyar, MD, DSc

ABSTRACT: Background. The long-term prognosis of diabetic patients with multivessel coronary artery disease (CAD) treated by surgical or percutaneous coronary revascularization is significantly worse as compared to non-diabetics. Lower rates of complete revascularization may be one factor that influences the poor long-term outcome in the diabetic population. Our study assessed the impact of complete revascularization on the long-term prognosis in diabetic patients with CAD treated by percutaneous coronary intervention (PCI). The study included 658 consecutive diabetic patients (m...

Intracoronary Brachytherapy for In-Stent Restenosis of the Left Anterior Descending Artery Via the Left Internal Mammary Artery

Joseph Aragon, MD and Frank Litvak, MD

Intravascular radiation is currently the only Food and Drug Administration-approved modality to treat in-stent restenosis (ISR).1,2 Multiple clinical trials have shown efficacy of beta-radiation in reducing intimal growth associated with ISR.3,4 The Galileo centering catheter (Guidant Corporation, Santa Clara, California) uses a balloon centering catheter to deliver a Phosphorus-32 (32P) radiation source to the area of restenosis. The catheter design includes a rapid-exchange lumen and a central lumen with a closed end to isolate the radiation source from the patient. The...

Percutaneous Coronary Revascularization in Diabetic Patients with Multivessel Coronary Artery Disease: Importance and Feasibilit

Rajendra H. Mehta, MD, MS and Michael H. Sketch, Jr., MD

Percutaneous coronary interventions (PCI) have been increasingly adopted for the treatment of coronary artery disease in patients with diabetes mellitus. This form of coronary revascularization is attractive because of its ability to avoid coronary artery bypass surgery (CABG), leading to shorter hospital stays and lower initial costs.1 Nonetheless, the inability to completely revascularize patients remains the ‘Achilles Heel’ of percutaneous coronary interventions.1 This limitation is much more apparent among patients with diabetes, who often have diffuse, severe, an...

Primary Stenting of an Anomalous Left Main Trunk Originating from the Right Coronary Artery During Acute Myocardial Infarction

Raúl Moreno, MD, Carlos Barrera-Ramírez, MD, José Garcia, MD, Carlos Macaya, MD

ABSTRACT: In 1.5–2.0% of patients with acute myocardial infarction referred for primary percutaneous coronary intervention, the left main trunk is identified as the culprit vessel. Among the congenital coronary anomalies, an anomalous origin of the left main trunk from the right sinus of Valsalva is very rare. A 73-year-old patient with lateral acute myocardial infarction was referred to primary angioplasty. The initial angiogram showed an anomalous origin of the left main from the right coronary artery, apparently with a septal course, with an angiographic image of intraluminal throm...

Interaction Between a Perfluorocarbon Emulsion and Radiographic Contrast Media

Ralf-Peter Franke, PhD, MD, Peter Reuter, PhD, Wolfgang Röhlke, PhD, *Klaus Matschke, MD, *Steffi Keller, MD, †Bernd Klosterhalfen, MD, †Christian Mittermayer, MD, §Christoph Mrowietz, PhD, §Friedrich Jung, PhD

ABSTRACT: This study evaluated specially designed perfluorocarbon (PFC) emulsions as blood substitutes in case of induced ischemia of the left heart ventricle in healthy farm pigs. Two hundred milliliters of perfluorocarbon emulsion were infused while 200 ml of blood were simultaneously drawn. Radiographic contrast media were given to aid placement of balloon catheters in the left coronary artery. Histopathological analysis showed that right heart failure caused the deaths of both pigs. Particles (up to > 3 µm) of foreign body materials obstructed capillaries of all organs analyzed (he...

One Stent Lost in Two Arteries

Alexander Goldberg, MD, Arthur Kemer, MD, Ganeshkumar Anne, MD, Luis Gruberg, MD

The use of stents during percutaneous coronary intervention is now increasingly common. Stent embolization into the systemic or coronary circulation before deployment is a rare but recognized complication of coronary stenting, with hazardous risk for the patient.1–4 Potentially fatal consequences of intracoronary embolization of balloon-mounted stents include coronary thrombosis and subsequent myocardial infarction.5,6 In the past, manual crimping of stents was associated with a significantly increased risk of stent disengagement and embolization. Although manually crim...

Validation of 4 French Catheters for Quantitative Coronary Analysis: In Vivo Variability Assessment Using 6 French Guiding Cathe

Marcelo Sanmartin, PhD, Javier Goicolea, MD, Raul Castellanos, MD, Marisol Bravo, MD, Raymundo Ocaranza, MD, Diogenes Cuevas, MD, Ramon Mantilla, MD, Rafael Ruiz-Salmeron, PhD

ABSTRACT: Although numerous studies have established the utility of 4 French (Fr) catheters for routine coronary angiography, its adequacy for automatic quantitative coronary analysis has not been previously assessed. Methods. In 32 consecutive patients, coronary angiography was performed sequentially with 4 Fr diagnostic catheters and 6 Fr guiding catheters after intracoronary nitroglycerin. A total of 43 lesions were evaluated for quantitative analysis using both types of catheter as scaling devices. Possible differences in the reference diameter, minimal luminal diameter and p...

Management of a Patient with ST-Segment Elevation Myocardial Infarction Immediately After Successful Coiling of a Basilar Tip An

Francis Q. Almeda, MD, Demetrius K. Lopes, MD*, Carl E. Eybel, MD

Case Report. We present the case of a 52-year-old male with a history of hypertension who presented to the Emergency Room (ER) of a community hospital with a 2-month history of progressively worsening exertional chest pressure. While in the ER, the patient had sudden onset of severe headache and lost consciousness. A stat CT scan of the head was performed, which revealed a subarachnoid hemorrhage with evidence of hydrocephalus. He was emergently transferred to a tertiary medical care center, where he was found to be unresponsive but with spontaneous movement of all extremities. Urgen...

Transcatheter Closure of Secundum Atrial Septal Defects with Complex Anatomy (Part I)

Carlos A.C. Pedra, MD, Simone R.F. Pedra, MD, César A. Esteves, MD, Renata Cassar, MD, Sérgio C. Pontes Jr., MD, Sérgio L.N. Braga, MD, Valmir F. Fontes, MD

ABSTRACT: The aim of this study was to evaluate the feasibility, safety and efficacy of transcatheter closure of secundum atrial septal defects (ASD) in patients with complex anatomy. From September 1997 to July 2003, a total of 40 patients (median age, 34 years; 65% female) with complex ASDs, defined as the presence of a large defect (stretched diameter > 26 mm) associated with a deficient rim (n = 23); multiple defects (n = 8); a multi-fenestrated septum (n = 5); and defects associated with an aneurysmal septum irrespective of their size (n = 4) underwent closure. The Helex device was...

Transcatheter Closure of Secundum Atrial Septal Defects with Complex Anatomy (Part II)

Carlos A.C. Pedra, MD, Simone R.F. Pedra, MD, César A. Esteves, MD, Renata Cassar, MD, Sérgio C. Pontes Jr., MD, Sérgio L.N. Braga, MD, Valmir F. Fontes, MD

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Transcatheter closure was successful in the remaining 35 patients (87.5%). The calculated Qp/Qs was 2.5 ± 0.8. All patients had normal to mildly elevated pulmonary artery pressures. The fluoroscopic and total procedure times ranged from 3–63 minutes (median time, 20 minutes) and 20–210 minutes (median time, 90 minutes), respectively. All patients with a single, large defect (n = 19) received an Amplatzer device, ranging in size from 26–38 mm (median, 32 mm; mean...

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