Volume 17 - Issue 11 - November, 2005

Soluble Mediators of Microvascular Dysfunction — Identifying the Invisible Culprits?

Pedro Martinezclark, MD and Joseph P. Carrozza Jr., MD

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...

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

Fayez E. Shamoon, MD, Shaddy K. Younan, MD, Elie Y. Chakhtoura, MD

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?

David G. Rizik, MD

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

Sanjeev Wasson, MD, Lokesh Tejwani, MD, Rajeev Angampally, MD, Greg Flaker, MD

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...

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

Sadi Gulec, MD, Cagdas Ozdol, MD, Uzeyir Rahimov, MD, Yusuf Atmaca, MD, Deniz Kumbasar, MD, Cetin Erol, MD

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 ...

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

Marcelo Sanmartin, MD, José Esparza, MD, Joaquin Moxica, MD, José Antonio Baz, MD, Andréas Iñiguez-Romo, MD

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...

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

Dennis Zavalloni, MD, Marco Rossi, MD, Guido Belli, MD, Melania Scatturin, MD, Emanuela Morenghi, PhD, Federica Marsico, MD, Giampiero Catalano, MD, Giovanni Tosi, MD, Paolo Pagnotta, MD, Patrizia Presbitero, MD

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

Ravi K. Ramana, DO, Dinesh Arab, MD, Dominique Joyal, MD, Lowell Steen, MD, Leslie Cho, MD, Bruce Lewis, MD, Jayson Liu, MD, Henry Loeb, MD, Ferdinand Leya, MD

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...

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 ...

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