Volume 16 - Issue 11 - November, 2004

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 ...

Diffuse Saphenous Vein Graft Spasm

Vaishali Ashar, MBBS, Giampaolo Niccoli, MD, Italo Porto, MD

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 ...

Primary Angioplasty of Unprotected Left Main Coronary Artery for Acute Anterolateral Myocardial Infarction

Koyu Sakai, MD, Yoshihisa Nakagawa, MD, Takeshi Kimura, MD, Kenji Ando, MD,
Hiroyoshi Yokoi, MD, Masashi Iwabuchi, MD, Katsumi Inoue, MD,Hideyuki Nosaka, MD,
Masakiyo Nobuyoshi, MD

Despite the advancements in acute myocardial infarction (AMI) treatment, AMI caused by acute unprotected left main coronary artery (LMCA) occlusion rapidly progresses to cardiogenic shock and death unless there are substantial preexisting intercoronary collaterals and adequate reperfusion can be readily established.1–3 Primary angioplasty expands the population amenable to reperfusion to patients ineligible for thrombolysis and is more effective for treating patients at high risk,4,5 the benefits being most impressive for shock patients.6
Acute LMCA occlusio...

Advanced Atheroscrelotic Plaque as a Potential Cause of No-reflow in Elective Percutaneous Coronary Intervention — Intravascular

*Shigenori Ito, MD, §Masanao Saio, MD, *Takahiko Suzuki, MD

No-reflow sometimes occurs in percutaneous coronary intervention (PCI) as a terrible complication with an incidence of 2–5%.1,2 No-reflow has been reported to be related to the presence of thrombus, lipid pool (vulnerable plaque), and other factors in acute coronary syndrome and occurs at a higher rate than in non-acute coronary syndrome. Thus, no-reflow is relatively rare in elective PCIs for native coronary arteries, having an incidence of about 1.0%.3 We have experienced 3 directional coronary atherectomy (DCA) cases that developed no-reflow, most likely due to dista...

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...

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