Volume 17 - Issue 11 - November, 2005

Coronary Perforation 2006 — Watch for the Wire

Ariel Roguin MD, PhD and Rafael Beyar MD, DSc

The number of percutaneous coronary interventions (PCI) performed worldwide is increasing. With the improvement of technology and interventional tools, the number of procedures is expected to further increase. As the range of equipment available to the interventional cardiologist evolves, together with necessary operator expertise, not only will the number of procedures increase, but interventionists will be treating patients with complex disease and more challenging coronary anatomy.
Among the most dreadful complications seen during PCI are abrupt vessel closure and perforations. Improveme...

Failure of the Symbiot PTFE-Covered Stent to Reduce Distal Embolization During Percutaneous Coronary Intervention in Saphenous V

Daniel J. Blackman, MD, Robin P. Choudhury, MD, Adrian P. Banning, MD, Keith M. Channon, MD

Within a decade of coronary artery bypass graft surgery, 50% of saphenous vein grafts fail, causing recurrent angina and acute coronary syndromes.1 Because of the substantial risk associated with re-operation, percutaneous intervention is often preferred to further surgery in this population. However, percutaneous revascularization is hampered by a high incidence of acute complications, specifically, distal embolization and periprocedural myocardial infarction (MI).2,3 Significant elevation in cardiac enzymes resulting from distal embolization is an independent predictor ...

Use of Endovascular Stents for the Treatment of Coarctation of the Aorta in Children and Adults: Immediate and Midterm Results

Lisa Shah, MD, Ziyad Hijazi, MD, Satindir Sandhu, MD, Annette Joseph*, RN, Qi-Ling Cao, MD

Coarctation of the aorta (CoA) accounts for 6–8% of all forms of congenital heart defects. In children and adults, balloon angioplasty has become the preferred treatment for patients with recurrent CoA.1–5,6–18 The application of this technique for treatment of native coarctation is somewhat controversial due to the high incidence of recoarctation (5–10%) and the incidence of aneurysm formation (5–7%).7 There are few reports in the medical literature documenting the beneficial use of stent implantation for the treatment of CoA.2–5,8–10,19 Stent im...

Rescue Percutaneous Coronary Intervention: A Review

Umesh K. Arora, MD and Meeney Dhir, MD

The primary goal of therapy for acute myocardial infarction (AMI) is rapid, complete and sustained restoration of infarct-related artery (IRA) blood flow and myocardial perfusion, with a consequent positive impact on the patient’s outcome. Both fibrinolytic and mechanical restoration of anterograde coronary blood flow in patients suffering AMI have shown to improve left ventricular function, reduce infarct size and reduce mortality.1–10 The benefits of myocardial reperfusion, including the prevention of infarct expansion and improvement of electrical stability, are amplified whe...

The “Zipper” Lesion: A Rare but Serious Guiding Catheter-Induced Complication of a PCI Procedure

Stéphane Cook, MD and David Tueller, MD

A 42-year-old man presented with heavy chest pain of four hours’ duration. Physical examination was unremarkable. The ECG showed an acute septoapical infarction. Nitroglycerin, aspirin, clopidogrel and heparin were administered, and an emergency coronary angiography was performed from the right femoral artery (Figures 1 A and B). The left anterior descending artery was occluded distally. The left main trunk ostium was deeply intubated by a slightly too large Q4 6 French intervention catheter. There was, however, no damping or ventriculization of pressure. The occlusion was crossed with a ...

Transcatheter Fenestration of Autologous Pericardial Extracardiac Fontan via the Transhepatic Approach

Michael R. Recto, MD, Walter L. Sobczyk, MD, Erle H. Austin III, MD

The Fontan operation was first described for management of univentricular heart disease in 1971. Since it was first described, there have been several modifications to the original operation.1 In 1988, de Laval2 first proposed the concept of total cavopulmonary anastomosis (construction of an intra-atrial lateral tunnel to connect the inferior vena cava to the pulmonary artery together with a bidirectional cavopulmonary shunt) as an alternative to atriopulmonary connection. The extracardiac approach remains popular because it eliminates the need for aortic cross-clamping,...

Acute Myocardial Infarction during Puerperium. Report of Two Cases of Multivessel Involvement Treated with Primary Coronary Inte

Santiago Jiménez Valero, MD, Eulogio García, MD, Juan Luis Delcán, MD

Acute myocardial infarction (AMI) is a rare event in pre-menopausal women, with only 0.7% of the total number of AMIs appearing in young women.1 The incidence of AMI in the Framingham study for women 35 to 44 years of age was 5.2 cases per 1,000 over a 10-year follow-up period.2
AMI is also an exceptional occurrence during pregnancy, delivery or puerperium, with a prevalence of approximately 1 out of every 10,000–30,000 pregnancies.1–3 Since the first description in 1922 by Katz,4 less than 200 cases have been reported. The condition is associa...

Feasibility Assessment of Aortic Valve Area in Patients with Aortic Stenosis Using a Pressure Wire through a 4 French System and

Stefan C. Bertog, MD, Andrew Smith, MD, Carmelo J. Panetta, MD

Symptomatic aortic stenosis can be associated with significant morbidity and mortality.1 Accurate assessment of the severity is important both to determine the association of symptoms with aortic stenosis and for optimal timing of surgical repair. In the majority of patients, the aortic valve area can be assessed noninvasively with accuracy by transthoracic echocardiography. However, due to poor images or other technical limitations with echocardiography, cardiac catheterization is occasionally necessary for valve area assessment. Calculation of the aortic valve area (AVA) relies on...

Release and Elimination of Soluble Vasoactive Factors during Percutaneous Coronary Intervention of Saphenous Vein Grafts: Analys

Joseph Salloum, MD, Carter Tharpe, MD, Douglas Vaughan, MD, David X. Zhao, MD

The no-reflow phenomenon is defined as a severe reduction in antegrade coronary flow in the absence of epicardial vessel obstruction.1 The presence of no-reflow substantially increases the risk of major adverse clinical events (MACE) in percutaneous coronary artery interventions (PCI), particularly in saphenous vein grafts (SVG).2,3 Mechanisms underlying no-reflow are not completely understood. Several hypotheses have been proposed, including microvascular spasm, in situ thrombosis and distal embolization. Distal protection devices are designed to prevent no-reflow...

Inadvertent Detachment of an Entrapped Cutting Balloon from the Balloon Catheter during Treatment of In-Stent Restenosis

Daniel Blackman, MD and Vladimir Dzavik, MD

The Cutting Balloon® (CB) (Interventional Technologies, Letterkerry, Ireland) employs three to four longitudinally mounted microblades that produce clean incisions into plaque or neointima, enhancing lesion dilatation.1 Its use has been advocated specifically for heavily calcified lesions, aorto-ostial disease, and in-stent restenosis (ISR).2–4 However, the microblades also render the current version of the balloon bulky and stiff. Several recent reports have described CB entrapment following dilatation for ISR, leading to inadvertent extraction of th...

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