Volume 16 - Issue 11 - November, 2004

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 ...

Six-Month Clinical and Angiographic Outcomes of the Tecnic Carbostent™Coronary System: The Phantom IV Study

*Gian B. Danzi, MD, *Cinzia Capuano, MD, *Marco Sesana, MD, *Roberto Baglini, MD, §Antonio L. Bartorelli, MD, §Daniela Trabattoni, MD, †Angela Migliorini, MD, †David Antoniucci, MD

The Tecnic Carbostent™ (Sorin Biomedica, Saluggia, Italy) is a balloon-expandable, stainless steel tubular coronary stent with a unique cellular design and proprietary Carbofilm permanent coating.1-3 Recently the stent has been pre-mounted on a new low-profile rapid-exchange delivery system. The aim of this study was to assess the procedural, in-hospital, and long-term clinical and angiographic outcomes of patients undergoing angioplasty with the new Tecnic Carbostent system for de novo coronary lesions.

Patient population. Between October 2001 and...

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...

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