Volume 16 - Issue 12 - December, 2004

Directional Atherectomy With the SilverHawk Plaque Excision Device in the Treatment of a Proximal Subclavian-Vertebral Artery

Ashish Pershad, MD and Jon Stevenson MD

Subclavian artery stenoses can, in patients who have undergone previous left internal mammary artery (LIMA) to left anterior descending (LAD) bypass grafting, lead to coronary-subclavian steal syndrome (CSSS).1 This occurs when a proximal subclavian lesion, leading to retrograde flow through the LIMA to feed the post-stenotic subclavian, causes symptomatic myocardial ischemia. A noticeable blood pressure gradient between the left and right arms is not uncommon. First described in 19772 and assigned a prevalence in the same year of 0.44%,3 CSSS has increased in ...

Successful Management of a Resistant, Focal Calcified Lesion Following Direct Coronary Stenting With a Cutting Balloon

Woong Chol Kang, MD, Tae Hoon Ahn, MD, Seung Hwan Han, MD, Seung Hwan Han, MD, Eak Kyun Shin, MD

Direct stenting is a feasible and safe technique, which may reduce the procedure time, cost and radiation exposure as well as result with less vessel injury. However, it is not suitable for coronary lesions with excessive calcification, severe proximal tortuosity or in small caliber vessels. We describe a patient with a heavily calcified lesion that was not apparent by fluoroscopy, and in which the high-pressure inflation of the stent balloon failed to fully expand the stent, but cutting balloon inflations with incremental balloon sizes and high pressure achieved full expansion of the stent....

Management of Right Coronary Artery Perforation During Percutaneous Coronary Intervention with Polyvinyl Alcohol Foam Embolizat

Ioannis Iakovou, MD and Antonio Colombo, MD

Coronary artery perforation is a rare but potentially catastrophic complication of percutaneous coronary intervention (PCI).1–3 The availability of polytetrafluoroethylene (PTFE) covered stents made a significant impact on the treatment of this complication. Still there are situations in which the perforation site is distal and not amenable to covered stent treatment. We describe a case of right coronary artery (RCA) perforation during a recanalization attempt of a chronic total occlusion complicated by impending tamponade and treated with transcatheter injection of polyvinyl alco...

Interventional and Peripheral Vascular Procedures Using Contrast Management: Tips and Techniques

Morton J Kern, MD

The following special CME section is underwritten through an educational grant from Bracco Diagnostics

The first cardiac catheterization reported occurred in 1929 in Germany, performed by Dr. Werner Forssmann.1 After anesthetizing his own arm and performing a cut-down on the brachial vein, he inserted a urologic catheter, passed it up to the heart, and then walked down two flights to stand in front of an X-ray machine, where he took the first catheterization radiograph.2 The image detail was relatively poor.
The selective injection of radiographic contrast med...

Treatment of Coronary Artery Disease in Dialysis Patients with Sirolimus-eluting Stents: 1-year Clinical Follow-up of a Consecut

Joost Daemen, Pedro Lemos, MD, Jiro Aoki, MD, Chourmouzios Arampatzis, MD, Angela Hoye, MD, Eugene McFadden, MD, Patrick Serruys, MD

In this preliminary series, sirolimus-eluting stent implantation appeared safe and effective for the treatment of dialysis patients with coronary artery disease. Dialysis patients are well known to be a high-risk population for cardiovascular morbidity and mortality, especially due to coronary atherosclerotic disease. However, the management of coronary disease in patients with end-stage renal failure is often problematic due to the presence of multiple co-morbidities and frequent limitations to drug prescription.1 Moreover, these patients have been reported to be at a higher risk f...

17beta-Estradiol and Restenosis: A Novel Vaso-Protective Role for Estrogen?

Baskaran Chandrasekar, MD

The possible role of estrogen in coronary artery disease (CAD) has been extensively studied. Prospective randomized clinical trials have not substantiated a beneficial role for estrogen in CAD. The Heart and Estrogen/Progestin Study follow-up (HERS II) did not demonstrate a reduced risk of CAD after 6.8 years of hormone replacement therapy.1 The Women’s Health Initiative (WHI) trial has concluded that overall health risks exceeded benefits with the use of hormone replacement therapy for a mean treatment period of 5.2 years.2 There is no longer any support for systemic e...

Safety of Percutaneous Coronary Intervention Alone in Symptomatic Patients with Moderate and Severe Valvular Aortic Stenosis and

Pramod Kuchulakanti, MD, Seung-Woon Rha, MD, PhD, Lowell F. Satler, MD, William O. Suddath, MD, Augusto D. Pichard, MD, Kenneth M. Kent, MD, Neil J. Weissman, MD, Edouard Cheneau, MD, Rajbabu Pakala, PhD, Daniel A. Canos, MPH, Ellen E. Pinnow, MS, Ron Waksman, MD

Aortic stenosis (AS) is prevalent in 2–7% of the population over 65 years of age.1 Atherosclerotic coronary artery disease (CAD) coexists in 27–43% of patients with AS.2 Management of CAD in patients with AS poses special problems since timing of surgery for AS depends on the development of symptoms, and treatment of CAD is often by concomitant coronary artery bypass graft (CABG) surgery. Surgical aortic valve replacement (AVR) is recommended in patients with moderate AS undergoing CABG, and in all patients with symptomatic severe AS.3 Whether PCI can be un...

The Evolving Role of Percutaneous Intervention in Coronary Artery Disease with Coexistent Aortic Stenosis

Jacqueline Saw, MD and Deepak L. Bhatt, MD

Aortic stenosis (AS) and coronary artery disease (CAD) are both prevalent, with recent studies showing similar lesion histology, and also an association between traditional atherosclerotic risk factors and the development of AS.1–3 The prevalence of calcific AS increases with age, affecting 2-3% of the population > 75 years of age.2,4 Coexisting CAD (>= 70% diameter stenosis) is present in approximately 40% of patients with AS.5 Therefore, patients who require aortic valve replacement (AVR) for AS often undergo concomitant coronary artery bypass surgery (CABG).
The key...

Comparison Between Glycoprotein IIb/IIIa Blockade and Distal Protection Device for the Restoration of Myocardial Perfusion Durin

Koon-Hou Mak, MD, Corinna Phay, BSc, Aaron Wong, MBBS, Veronica Kwok, RN, Kok-Soon Tan, MBBCh, Kean-Wah Lau, MBBS, Tian-Hai Koh, MBBS

The key treatment strategy for patients with acute ST-segment elevation myocardial infarction (MI) is rapid complete restoration of antegrade coronary flow.1–6 Recognition of distal embolization of atherothrombotic debris in the microvasculature7 highlighted the significance of tissue level myocardial reperfusion8 in both fibrinolytic9 and catheter-based10,11 therapies. Indeed, the “no-reflow” phenomenon occurs in >= 25% of patients with brisk antegrade flow following recanalization of anterior MI.12 Indeed, the occurrence...

The Function of the Left Ventricle After Complete Multivessel One-Stage Percutaneous Coronary Intervention in Patients With Acut

Andrzej Ochala, MD, Grzegorz A. Smolka, MD, Wojciech Wojakowski, MD, Dariusz Dudek, MD, Artur Dziewierz, MD, Zbigniew Krolikowski, MD, Zbigniew Gasior, MD, Michal Tendera, MD

Acute ST-segment elevation acute myocardial infarction (STEMI) is one of the main causes of morbidity, hospitalization and consequently increases healthcare costs. The primary goal of therapy in STEMI is to regain patency of the culprit vessel (TIMI 3 flow) and achieve myocardial reperfusion. Timely reperfusion of jeopardized myocardium represents the most effective way of restoring the balance between myocardial oxygen supply and demand. Primary percutaneous coronary intervention (PCI) was shown to be superior to thrombolytic therapy in terms of a higher patency rate (> 90%) of the infarct-re...

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Editorial Correspondence
  • Laurie Gustafson, Executive Editor, JIC
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