Volume 16 - Issue 11 - November, 2004

Primary Angioplasty Without On-site Surgical Back-up: The First Experience with Mobile Catherization Facility

Ramazan Akdemir, MD, Hakan Ozhan, MD, Enver Erbilen, MD, Mehmet Yazici, MD, Sinan Albayrak, MD, Huseyin Gunduz, MD, Cihangir Uyan, MD

Multi-center randomized trials indicate that primary angioplasty in acute myocardial infarction (AMI) lowers the rates of death, stroke, recurrent ischemia and re-infarction compared with fibrinolytic therapy.1 For low-risk patients with AMI, the mortality of primary angioplasty can be very low (2 Furthermore, most AMI patients included in these studies were not candidates for fibrinolytic therapy, either because they had bleeding risks or shock, or did not have diagnostic electrocardiograms.3 These subgroups of pati...

Primary PCI Without On-site Surgery and Without On-site Cath Lab

Ubeydullah Deligonul, MD

Modern treatment of acute myocardial infarction is based on early and complete reperfusion. The time between the onset of myocardial infarction and reperfusion determines the mortality benefit and is influenced by various factors including a large delay in seeking medical attention by the patients.1 The best strategy for reperfusion has been an area of ongoing research. Emergency primary percutanoeus intervention (PCI) is superior to thrombolysis in selected cases.2 To make early primary PCI available to a wider population, various strategies, including PCI in catheteriza...

Adjunctive Therapy for Cardiovascular Intervention — Its Time Has Come

Deepak L. Bhatt, MD

It is with great excitement that The Journal of Invasive Cardiology will be initiating a new section called “Adjunctive Therapy.” While much of the focus of cardiovascular intervention relies upon mechanical approaches to improve perfusion, it has become clear in recent years that adjunctive pharmacotherapy is critical to improve upon the results obtained by mechanical means alone. Specific examples include the introduction of the intravenous glycoprotein IIb/IIIa inhibitors and more recently the direct thrombin inhibitor bivalirudin.1,2 Indeed, without the incorporation of dual...

The Angiomax Peripheral Procedure Registry of Vascular Events Trial (APPROVE): In-Hospital and 30-Day Results

David Allie, MD, Patrick Hall, MD, Nicolas W. Shammas, MD, Robert Safian, MD, John R. Laird, MD, John J. Young, MD, Ajay Virmani, MD

Peripheral arterial disease (PAD) affects 8–12 million Americans with an estimated 12–20% of the population > 65 years of age afflicted. Approximately 50% of patients are asymptomatic, which may explain why this disease is often under-diagnosed and thus under-treated.1 As the population ages and awareness increases, the prevalence of PAD will increase. PAD is associated with significant mortality and morbidity, and patients with PAD undergoing procedures are at an increased risk for ischemic and hemorrhagic events.2 Peripheral procedures are often technically more com...

Acute Right Coronary Artery Occlusion in an Adult Patient After Radiofrequency Catheter Ablation of a Posteroseptal Accessory Pa

Truong Duong, MD, Peter Hui, MD, James Mailhot, MD

Radiofrequency catheter ablation (RFCA) of accessory pathways (APs) is recommended as definitive therapy for symptomatic or life-threatening tachyarrhythmias associated with the Wolff-Parkinson-White (WPW) syndrome. Although various complications have been reported with this procedure, acute coronary occlusion as a consequence of RFCA is a very rare adverse outcome. We describe the first adult patient with acute RCA occlusion following RFCA of a posteroseptal AP, which was subsequently treated successfully with balloon angioplasty.

Case Report. A 25-year-old man presented to the e...

Reversible Pulmonary Hypertension in a Patient Treated with Protacylcin

Peter J. Engel,1 MD, Robert Baughman,2 MD, Heide Johnson,1 RN, Dean J. Kereiakes,1 MD

Untreated pulmonary hypertension is a relentlessly progressive disorder leading to death from right ventricular failure, regardless of etiology. In recent years, more effective medical therapy has become available for this condition. In particular, intravenous prostacyclin has been shown to improve symptoms, exercise tolerance, and prognosis in pulmonary arterial hypertension.1
Among the many drawbacks of intravenous prostacyclin is the usual requirement for permanent continuation of therapy. Patients started on this agent are advised that it is very unlikely that it will ever be s...

The Novel Use of a Covered Stent in the Management of a Left Internal Mammary Artery to Pulmonary Vasculature Fistula

Benedict M. Glover, MD, MRCP and Mazhar M. Khan, FRCP

Left internal mammary artery (LIMA) to pulmonary vasculature fistulas are rare complications following coronary artery bypass surgery. In symptomatic cases, management tends to be either conservative or surgical ligation of the fistula. This case describes the use of a covered JOSTENT (Jomed GmbH Rangendingen, Germany) to occlude the origin of the fistulous communication.

Case Report. A 79-year-old male with a history of coronary artery disease, type 2 diabetes mellitus and hyperlipidemia presented with a recurrence of unstable angina resulting in multiple hospital a...

Superior In-Hospital and 30-Day Outcomes with Abciximab Versus Eptifibatide: A Contemporary Analysis of 495 Consecutive Percutan

Efthymios N. Deliargyris, MD, Bharathi Upadhya, MD, Robert J. Applegate, MD, Michael A. Kutcher, MD, Sanjay K Gandhi, MD, David C. Sane, MD

Over the past decade clinical trials have demonstrated that platelet glycoprotein (GP) IIb/IIIa receptor inhibition dramatically reduces the ischemic complications of percutaneous coronary intervention (PCI).1–6 Currently, there are 3 approved GP IIb/IIIa inhibitors for use during PCI; the chimeric monoclonal antibody abciximab (Reopro® Eli Lilly and Co., Indianapolis, Ind.), the peptidomimetic tirofiban (Aggrastat® Merck & Co., Inc., ) and the heptapeptide eptifibatide (Integrilin Cor Therapeutics). Significant structural, pharmacokinetic, an...

Distal Protection of the Left Anterior Descending Artery with the EX Filter Wire During an Acute Coronary Syndrome

Ashish Pershad, MD and Jon Stevenson, MD

Distal coronary embolization is an unpredictable complication of percutaneous coronary intervention (PCI). No reflow, distal coronary occlusion and peri-procedural cardiac enzyme elevation (“infarctlets”) may result from distal embolization. Traditional treatment for these phenomena has focused on distal microvasculature vasodilators like nitroprusside, verapamil, and adenosine. Enthusiasm for embolic protection during PCI has increased with studies suggesting lower peri-procedural complications and major adverse cardiac events with their use.1,2 Thrombus aspirators (TEC, Interv...

Coronary Pressure Notch: An Early Non-hyperemic Visual Indicator of the Physiologic Significance of a Coronary Artery Stenosis

David Holmes, MD, Priya Velappan, MD, Morton J. Kern, MD

The limitations of coronary angiography for defining the functional significance of intermediately severe lesions are well known. Such angiographic presentations frequently require additional testing to determine their clinical relevance. During cardiac catheterization, a pressure sensor angioplasty guidewire can be placed across a stenosis to accurately assess the physiological significance of a coronary lesion by measuring myocardial fractional flow reserve (FFR).1 Utilizing ratio of the mean pressures distal and proximal to the stenosis during maximal hyperemia, FFR values of ...

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