Volume 16 - Issue 12 - December, 2004

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...

Which Is The True Channel?

Abdul R. Halabi, MD, Michael H. Sketch Jr., MD, James E. Tcheng, MD

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

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...

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