Volume 16 - Issue 3 - March, 2004

Cutting Balloon Angioplasty to Treat Carotid In-Stent Restenosis

Michael R. Tamberella, MD, Jay S. Yadav, MD, Christopher T. Bajzer, MD, Deepak L. Bhatt, MD, Alex Abou-Chebl, MD

ABSTRACT: We describe a case of carotid artery restenosis following carotid artery stenting for treatment of post-endarterectomy stenosis. The goal is to highlight the risk of recurrent restenosis following endarterectomy. In this case report, we describe the use of cutting balloon therapy as a reasonable alternative to repeat surgical revascularization.

Key words: arteriosclerosis, cerebrovascular disorders, endarterectomy

With the recent presentation of the SAPPHIRE trial1 favoring carotid stenting with protection compared to carotid endarterectomy in ...

March 2004

Richard E. Shaw, PhD, FACC

Dear Readers,

This issue of the Journal of Invasive Cardiology coincides with the annual scientific sessions of the American College of Cardiology and includes original research articles, commentaries, review articles, case reports and offerings from our journal special sections Acute Coronary Syndromes, Interventions in Peripheral Vascular Disease, Clinical Decision Making and Clinical Images.

The research articles in this issue cover a broad range of topics that touch on important aspects of patient care. The first resear...

Low-Molecular-Weight Heparins and Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes (Part I)

James Ferguson, MD

ABSTRACT: Traditional antithrombotic regimens for the management of acute coronary syndromes are far from optimal. There is considerable opportunity for improvement of standard treatment with unfractionated heparin and aspirin. The introduction of new antithrombotic drugs, such as low-molecular-weight heparins (LMWH), and more potent antiplatelet drugs, such as glycoprotein (GP) IIb/IIIa antagonists, has the potential to significantly improve clinical outcomes. The complementary anticoagulant/antiplatelet modes of action of LMWHs and GP IIb/IIIa antagonists mean that combining these dru...

Low-Molecular-Weight Heparins and Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes (Part II)

James Ferguson, MD

Continued from previous page

Several other recent studies have also examined the efficacy and safety of the combination of LMWHs and GP IIb/IIIa antagonists in the catheterization laboratory (Table 1). Kereiakes et al. reported the results of a pilot study comparing two doses of dalteparin (40 or 60 IU/kg) in combination with abciximab for anticoagulation during elective PCI in 107 patients.46 Randomized enrollment was halted because three acute thrombotic events occurred in the 40 IU/kg ...

Severe Intravascular Hemolysis Following Mitral Valve Repair

Truong Duong, MD,* Rahul N. Khurana, MD§, Richard A. Francoz, MD*

ABSTRACT: We report two cases of severe intravascular hemolysis (IVH) following mitral valve repair using a Cosgrove-Edwards ring. In both cases, the degree of mitral regurgitation (MR) seen postoperatively worsened significantly compared to intraoperative transesophageal echocardiogram. Both patients required reoperation with mitral valve replacement with immediate resolution of the hemolysis. We hypothesize that the mitral regurgitation in the setting of an inadequate mitral valve repair is responsible for the hemolysis and propose various mechanisms to explain this pathophysiology. A...

Stent Implantation for Coronary Aneurysm with Edge Stenosis: Angiographic and Intravascular Analysis

Benjamin M. Wu, MD, PhD, Mamoo Nakamura, MD, Mehrdad Rezaee, MD, PhD

ABSTRACT: The incidence of coronary artery aneurysms is about 1–2%, with clinical course dependent on the size of the aneurysm. A case of moderate-size aneurysm in the proximal left anterior descending coronary artery with stenosis at both edges is presented. This was interrogated with intravascular ultrasound (IVUS), and based on the patient’s presentation, a single stent, size-matched 1:1 to the proximal reference, was placed across the aneurysm and both lesions. Post-implantation IVUS demonstrated residual stenosis and minimal change in the “neck” size of the aneurysm. At 4 m...

Use of PercuSurge GuardWire in Native Coronary Arteries During Acute Myocardial Infarction

Cameron Haery, MD, Jose E. Exaire, MD, Deepak L. Bhatt, MD, Jay S. Yadav, MD, Irving Franco, MD, Stephen G. Ellis, MD

One of the most challenging scenarios encountered during the percutaneous treatment of acute coronary syndromes (ACS) is the presence of thrombus, and the subsequent distal embolization due to mechanical disruption of the culprit lesion.1 Resultant epicardial vessel and microvascular impedance to flow contributes to long-term left ventricular dysfunction, congestive heart failure and death.2–5 Preventing distal embolization during percutaneous coronary intervention (PCI) in ACS is therefore of the utmost importance. The PercuSurge GuardWire (Medtronic, Minneapolis, Minn...

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...

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