Volume 16 - Issue 11 - November, 2004
Distal Protection of the Left Anterior Descending Artery with the EX Filter Wire During an Acute Coronary Syndrome
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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
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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 < 0
Diffuse Saphenous Vein Graft Spasm
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Case Report. A 53-year-old man presented with a history of angina at rest, a small troponin rise and ischaemic inferior ECG changes. He had undergone aortocoronary bypass operation for triple vessel disease 3 years before this admission. The left internal mammary (LIMA) was implanted to the left anterior descending (LAD). Two segments of the saphenous vein were grafted to the first obtuse marginal (OM1) and the right coronary artery (RCA). Cardiac catheterisation from the right femoral artery demonstrated extensive atheromatous disease of the native vessels. Both the LIMA to LAD and
Superior In-Hospital and 30-Day Outcomes with Abciximab Versus Eptifibatide: A Contemporary Analysis of 495 Consecutive Percutan
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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
The Novel Use of a Covered Stent in the Management of a Left Internal Mammary Artery to Pulmonary Vasculature Fistula
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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
Acute Right Coronary Artery Occlusion in an Adult Patient After Radiofrequency Catheter Ablation of a Posteroseptal Accessory Pa
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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
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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
Primary PCI Without On-site Surgery and Without On-site Cath Lab
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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
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