Volume 16 - Issue 12 - December, 2004

Which Is The True Channel?

Case report. A 70-year-old woman with a history of smoking, hypertension and hyperlipidemia was referred for evaluation of exertional angina that had developed over the preceding 6 months. Thirteen years earlier, she had undergone balloon angioplasty of the mid-RCA following acute myocardial infarction. That procedure resulted in an acceptable final residual stenosis (estimated to be 25% by visual severity), but was notable for the creation of a longitudinal dissection at the angioplasty site. Current diagnostic cardiac catheterization documented the presence of a disrupted-looking s



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

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



Flexions of the Popliteal Artery: Dynamic Angiography712

EDITOR’S NOTE: This article by Diaz et al. contains extremely valuable information. The importance of assessing the “dynamic anatomy” of the popliteal artery (and other vessels) was only recently appreciated as a result of developments with endovascular therapy and the increasing use of fracture-prone intraluminal metallic stents. The findings described by the Argentinian group should prove useful to interventionists who are planning to perform a stenting procedure in a given patient. But even more so, they will likely have an impact on current R&D efforts and concepts surround



A Prospective, Randomized Trial to Determine the Early and Late Reactions After the Use of Iopamidol 340 (Niopam™) and Iobitri

Intravascular contrast is a prerequisite for modern invasive cardiology. The contrast agents used for various procedures have become increasingly safe in recent years. Compared to ionic agents, the modern non-ionic contrast agents are fairly well tolerated, with a low incidence of serious adverse reactions.1,2 Serious adverse events associated with contrast agent such as ventricular fibrillation do occur in a few patients. It is not known whether the fibrillation threshold is different between these agents in clinical practice. Patients continue to experience uncomfortable and distr



Stabilization of Renal Function Following Renal Artery Stent Revascularization

The progressive nature of atherosclerotic renal artery stenosis is now well recognized.1–8 Observational data suggests that untreated renal artery stenosis can lead to progressive hypertension, renal insufficiency, and increased mortality.6,9–11 The incidence of progressive ischemic nephropathy resulting from atherosclerotic renal artery stenosis had been underestimated in the past. The U.S. Renal Data System annual report in 1999 revealed that up to 20% of new patients > 50 years old requiring hemodialysis have underlying renovascular disease.12
Medical



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

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



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

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

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



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