Volume 16 - Issue 11 - November, 2004

PCI for Acute Myocardial Infarction Caused by Left Main Disease

On Topaz, MD, FACC

Percutaneous revascularization of left main coronary lesions is a hot topic. During the recent TCT conference, multiple live cases and discussions were dedicated to new advancements in the treatment of left main disease. The high level of interest stems from recognition of the tremendous contribution of drug-eluting stents to successful long-term treatment of atherosclerotic coronary disease and from a prevailing feeling among interventionalists that with recent improvements of other types of equipment the field is ready to approach the “last frontier.”
Left main coronary disease is a rar...

Successful Revascularization of a Long Chronic Total Occlusion With Blunt Microdissection Complicated by Coronary Artery Dissect

1,2Jeffrey D. Lorin, MD, 2Jason R. Boglioli, MD, 1,2Steven P. Sedlis, MD

Percutaneous revascularization of chronic total occlusions (CTOs) represents an important clinical challenge in interventional cardiology. A CTO is defined as, “an obstruction of a native coronary artery for greater than 30 days with no luminal continuity and with thrombolysis in myocardial infarction (TIMI) flow grade 0 or 1.”1 These lesions account for approximately 10% of all percutaneous transluminal coronary angioplasty (PTCA) procedures.2 However, the angioplasty of CTOs is frequently limited by both an inability to successfully pass a guidewire across the occlusion and th...

Predictors of Survival After Contemporary Percutaneous Coronary Revascularization for Acute Myocardial Infarction in the Real Wo

Chi Hang Lee, MRCP, Ron T. van Domburg, PhD, Angela Hoye, MRCP, Pedro A. Lemos, MD,
Kengo Tanabe, MD, Pieter C. Smits, MD, PhD, Willem J. van der Giessen, MD, PhD, Pim de Feyter, MD, PhD, Patrick W. Serruys, MD, PhD

Management strategies for ST-elevation myocardial infarction (STEMI) have undergone great evolution over the past decade. Currently, primary mechanical reperfusion is considered superior to thrombolytic therapy in achieving complete and sustained reperfusion of the infarct-related coronary artery, resulting in lower rate of mortality and re-infarction.1–3 In many developed countries, patients presenting with STEMI are often directly transferred to the cardiac catheterization laboratory for mechanical reperfusion.
In parallel to this approach, there have been tremendous advents i...

Transcatheter Treatment of Lutembacher Syndrome: Combined Balloon Mitral Valvuloplasty and Percutaneous Atrial Septal Defect Cl

*Mariano Ledesma, MD, Patricio Martinez, MD, Miguel Angel Cázares, MD, §Ted Feldman, MD

Lutembacher syndrome is a rare combination of congenital ASD and acquired rheumatic mitral stenosis. It is usually treated by surgical correction. We describe a case of Lutembacher syndrome that was treated successfully with percutaneous Inoue balloon mitral valvuloplasty and closure of the atrial septal defect with an Amplatzer atrial septal occluder.

Case Report. A 39-year-old female was sent for evaluation for open heart surgery for mitral stenosis and ASD. She complained of dyspnea, palpitations and decreased exercise tolerance. Transthoracic echocardiogram (TTE) showed modera...

Bacteremia Following Complex Percutaneous Coronary Intervention

David Ramsdale, MD, Shahid Aziz, MRCP, Nick Newall, MRCP, Nick Palmer, MD, Mark Jackson, PhD

Bacteremic complications after cardiac catheterization and percutaneous coronary intervention are perhaps surprisingly rare considering the frequency of entry into the circulation of arterial sheaths, guide catheters, guidewires, balloon catheters, stents, atherectomy and thrombectomy devices, pressure wires and intravascular ultrasound catheters during complex coronary interventional procedures. Although septic endarteritis1,2 and coronary stent infection3,4 have been reported after percutaneous transluminal coronary angioplasty (PTCA), the incidence of bacteraemia after...

Nickel Allergy and the Amplatzer Septal Occluder

Harinder Singh, MD, Daniel R. Turner, MD, Thomas Forbes, MD

Transcatheter device closure of atrial septal defect (ASD) is an alternative to surgical closure. Currently, the Amplatzer Septal Occluder (ASO) (AGA Medical Corp, Golden Valley, Minnesota) is the only device approved for ASD closure in the United States. Several other closure devices are available in study protocols. Nitinol, an alloy composed of 55% nickel and 45% titanium1,2 is a component of many devices. The ASO contains the greatest amount of nickel. We report a case of nickel allergy that altered our choice of device for transcatheter ASD closure.

Case Report. A 54-year-old...

Vasoreactivity of the Radial Artery After Transradial Catheterization

Marcelo Sanmartin, MD, Javier Goicolea, MD, Raymundo Ocaranza, MD, Diogenes Cuevas, MD, Francisco Calvo, MD

The radial artery provides a safer alternative for left heart catheterization compared to femoral or brachial arteries, and also allows early mobilization without the need for closure devices.1 However, due to the similar dimensions of radial arteries and catheterization sheaths, significant injury of the vessel wall becomes a matter of concern, especially when considering the use of this artery for repeated cardiac procedures, as a bypass conduit, or dialysis fistulas. Although radial artery occlusion is the most common clinical expression of damage induced by catheterization, anot...

Unprotected Left Main “Kissing” Stent Implantation With a Percutaneous Ventricular Assist Device

Srihari S. Naidu, MD, Sameer Rohatgi, MD, Howard C. Herrmann, MD, Ruchira Glaser, MD

Case Report. An 80-year-old man with severe chronic obstructive pulmonary disease, chronic renal insufficiency and significant carotid artery disease presented with a 4-day history of episodic severe substernal chest pressure at rest. Echocardiography showed severe left ventricular dysfunction (ejection fraction 10%), anterior wall akinesis and moderate mitral regurgitation. Cardiac catheterization revealed a 95% distal left main (LM) coronary artery stenosis that involved the ostia of both the left circumflex (LCx) artery and the left anterior descending (LAD) artery, which was also...

Transradial Catheterization: The Road Less Traveled

Nitin Barman, MD, John H. Chiu, MD, Stephen G. Ellis, MD

Retrograde cannulation of a peripheral artery is a necessary step for current percutaneous coronary procedures. Since the first reported case of coronary angiography via the radial artery by Campeau in 1989, the transradial approach has been well studied. Large randomized clinical trials comparing transradial catheterization to traditional access have demonstrated advantages with respect to patient comfort, cost containment, and greatly reduced local vascular complications.2–4 In one representative study, major entry site complications were absent in the transradial group and pres...

Editor's Message (Nov. 2004)

Richard E. Shaw, PhD, FACC

Dear Readers,

This issue of The Journal of Invasive Cardiology, which coincides with the American Heart Association Annual Scientific Sessions, includes original research articles, case reports, reviews, and articles from the journal’s special sections, Electrophysiology Corner, Clinical Images, and a new special section titled Adjunctive Therapy, edited by Dr. Deepak Bhatt from the Cleveland Clinic.

The first research article by Dr. Efthymios Deliargyris and colleagues from the Wake Forest University School of Medicine in Winston-Salem, North Carolina, features ...

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