Volume 16 - Issue 12 - December, 2004

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...

Stabilization of Renal Function Following Renal Artery Stent Revascularization

Mayra Guerrero, MD, Aziz Ahmed, MD, Mumtaz Siddiqui, MD, Atul Trivedi, MD, Sandeep Khosla, MD

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 ...

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

Kunadian Vijayalakshmi, MBBS, MRCP, David Williams DCR(R), Robert A Wright, MD, FRCP, James A Hall, MA, MD, FRCP, Alun A Harcombe, MD, MRCP, Nicholas J Linker, MD, FRCP, FESC, Michael J Stewart, MD, FRCP, Adrian Davies, BSc, MB, FRCP, Mark A de Belder, MA, MD, FRCP

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...

Flexions of the Popliteal Artery: Dynamic Angiography712

Jose A. Diaz, MD, Miguel Villegas, MD, Gustavo Tamashiro, MD, Marisa H. Miceli, MD, Daniel Enterrios, MD, Aristobulo Balestrini, MD, Alberto Tamashiro, MD

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...

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