Volume 17 - Issue 11 - November, 2005

Poor Outcome in Patients Treated with Brachytherapy for Diffuse In-Stent Restenosis. The Role of Additional Stenting Despite Pro

The recurrence of coronary in-stent restenosis has been significantly reduced by brachytherapy.1–3 Patients treated with brachytherapy are characterized by poor outcomes in concomitant stent deployment, mainly because of late vessel thrombosis.1,2,4 In the treatment of in-stent restenosis, additional stents may be required for either suboptimal results or residual flow-limiting dissections.5,6 The risk of late vessel thrombosis has been overcome by prolongation of double antiplatelet therapy,7 however specific studies focusing on the influence of



Coronary Artery Perforation During Percutaneous Coronary Intervention: Incidence and Outcomes in the New Interventional Era

Coronary artery perforation (CP) is a rare and potentially life-threatening complication of percutaneous coronary intervention (PCI). CP has historically been reported to occur in 0.1–3.0% of PCI procedures.1–5 Although CP can be caused by coronary wires and balloon angioplasty,6 they are more frequently reported in PCI using atheroablative devices, stenting and excimer laser coronary angioplasty.2
In coronary artery perforations, the vessel damage may range from vessel puncture by the coronary wire, resulting in minimal dye staining to vessel rupture, fol



Safety and Efficacy of a Multipurpose Coronary Angiography Strategy Using the Transradial Technique

Transradial coronary percutaneous procedures are associated with reduced entry site complications compared to transfemoral or transbrachial techniques.1–4 However, the transradial approach is technically more challenging and time-consuming,4 which explains its less widespread acceptance as compared to the transfemoral approach. Nonetheless, over the past ten years, considerable improvements have been achieved in catheter configuration and design, and a great variety of transradial-dedicated material is now available. The availability of specifically designed arterial sh



Myonecrosis after Elective Percutaneous Coronary Intervention: Effect of Clopidogrel-Statin Interaction

Myocardial injury after percutaneous coronary interventions has been recognized as a frequent and prognostically important event.1 Multiple institutions have now reported follow-up studies of percutaneous revascularization, and the evidence supports a relation between the elevation of cardiac enzymes and poorer clinical outcomes during subsequent clinical evaluations.1–4 Recent studies presented evidence that statin therapy before percutaneous coronary interventions (PCI) is associated with a marked improvement in short- and long-term prognosis.5,6 Reduction



“Buddy Wire” Technique to Overcome Proximal Coronary Tortuosity During Rotational Atherectomy

Rotational atherectomy remains a valuable tool with specific niche indications in the percutaneous interventional management of obstructive coronary disease.1 Recent studies suggest that plaque modification of severely calcified coronary lesions with rotational atherectomy facilitates stent deployment and increases the procedural success rate.1–3 Advancement of the Rotablator® burr (Boston Scientific Corporation, Natick, Massachusettts) may, in some cases, be hampered by intrinsic vessel characteristics such as proximal tortuosity and diffuse intra-luminal a



More Stents, Fewer LIMAs?

Since Robert Goetz first performed a single mammary artery bypass to the anterior descending artery in 1960, its evolution has been associated with unparalleled clinical benefit in terms of symptom relief and a favorable effect on mortality, particularly in diabetics and those with multivessel disease. In fact, there have been few, if any, treatment strategies in all of modern vascular medicine that rival the beneficial impact of the mammary artery anastamosis, specifically when used to treat disease involving the left anterior descending (LAD) coronary artery.2–10
The current s



Single Coronary Artery with the Absence of a Left Anterior Descending Artery

Congenital coronary anomalies are asymptomatic and usually go unrecognized until the time of sudden cardiac death, especially in young athletes participating in competitive sports.1 The incidence of anomalous origin of coronary arteries ranges from 0.17% in autopsy studies to 1.2% in populations undergoing coronary arteriography.2,3 Davis et al., in a recently published prospective series of 2,388 children, identified anomalous origin of coronary arteries by transthoracic echocardiography in 0.17% of the study population.4

Case Report. A 40-year-old white wom



Soluble Mediators of Microvascular Dysfunction — Identifying the Invisible Culprits?

Percutaneous intervention of saphenous vein grafts is associated with approximately 20% risk of major adverse cardiovascular events secondary to decreased antegrade flow or “no-reflow” during the procedure.1 The mechanism of this phenomenon is probably multifactorial and involves microvascular dysfunction and potentially platelet-mediated loss of capillary autoregulation. Since the typical vein graft lesion is friable with large plaque volume, it may be that embolization of thrombotic and atheromatous material during the intervention is the trigger that starts a cascade of event



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