Volume 18 - Issue 2 - February, 2006

Adjunctive Antiplatelet Therapy during Rescue PCI

John J. Young, MD and Dean J. Kereiakes, MD

The treatment of ST-segment elevation myocardial infarction (STEMI) continues to evolve due to the adoption of antiplatelet and anticoagulation regimens in combination with pharmacologic (fibrinolysis) and/or mechanical reperfusion. Rapid, complete and sustained restoration of infarct-related artery (IRA) blood flow and myocardial perfusion directly impacts patient outcomes, with improvement in left ventricular function and reduction in infarct size and mortality.1–5 Current fibrinolytic regimens appear to have reached a therapeutic ceiling, with normal (TIMI grade 3) IRA flow bei...

Sequential Balloon Dilatation for Combined Aortic Valvular Stenosis and Coarctation of the Aorta in a Single Catheterization Pro

Kursad Tokel, MD, Selman Vefa Yildirim, MD, Birgul Varan, MD, Enver Ekici, MD

Combined aortic valvular stenosis (AVS) and coarctation of the aorta (CoA) is uncommon.3–5 This combination was detected in 7% of a large group of children with CoA who underwent balloon angioplasty.2 The long-term results of percutaneous balloon dilatation for isolated AVS and isolated CoA are favorable, and this treatment is widely used today, particularly for palliation.3–5
In 1987, Pan et al.6 reported the initial results for 2 patients with combined AVS and CoA who were treated with sequential balloon dilatation during a single catheterizat...

Biodegradable Stents: They Do Their Job and Disappear

Ron Waksman, MD

Coronary stenting has become the default device in percutaneous coronary interventions (PCIs). Coronary stents are used as a mechanical means to overcome the major limitations of balloon angioplasty with enabling scaffolding and the prevention of early recoil and late vascular remodeling.1–3 The major limitations of stents are thrombosis and restenosis. While thrombosis has been controlled with the use of antiplatelet therapy, restenosis has been significantly reduced with the use of drug-eluting stents. Nevertheless, the role of stenting is temporary and is limited to the interve...

Percutaneous Retrograde Revascularization of Lower Extremity Vessels by Using the Dorsalis Pedis Artery: Two Case Reports

Ashish Awasthi, MD, Yassar Almanaseer, MD, Thomas LaLonde, MD, Thomas Davis, MD

Peripheral artery disease (PAD) is commonly found in association with coronary artery disease (CAD) and is also considered a marker for CAD.1,2 There has been an increase in the treatment options for PAD with an increasing number of endovascular options becoming available.3 PAD involving the lower extremities usually presents with claudication, or in more severe cases, with chronic limb ischemia. Endovascular therapy for PAD in the lower extremities requires angiography of the affected vessel, followed by appropriate percutaneous intervention, if indicated. The commonly u...

Coronary Bifurcation Stenting: From Crush to Culotte. Avoiding Limerence and Meme Propagation?

Roberto Baglini, MD, PhD, Duccio Baldari, MD, Giuseppe Mezzapelle, MD

The Wikipedia term “crush” refers to a short-lived and unrequited love or limerence (“to crush on”). The primary characteristics of limerence can be summarized as intrusive, perhaps obsessive thinking about the limerent object and acute longing for reciprocation. Limerent people can act as a reservoir of memetic ideas as expressed in Karl Popper’s Conjectures and Refutations (1963). From his point of view, theories that better survive the process of refutation are actually not more true, but rather, more “fit”.1 The limerent attitude of interventional cardiologists to ...

Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention

Srihari S. Naidu, MD and Shing-Chiu Wong, MD

Case Description. A 69-year-old female with hypertension and hyperlipidemia presented with a 2-month history of worsening exertional angina. Nuclear perfusion imaging indicated ischemia in the inferior and inferoposterior walls, with preserved left ventricular function. Coronary angiography was notable for severely calcified vessels and a right dominant circulation. The left anterior descending and left circumflex arteries were free of critical stenosis, but the right coronary artery was tortuous in its proximal segment, with a 99% mid-vessel lesion that appeared as a calcified, obst...

Saphenous Vein Graft Rheology Simulating a Thrombotic Lesion

Adrian F. Low, MD, Eugene Pomerantsev, MD, Margaret Ferrell, MD

Case Presentation. A 59-year-old male was admitted for accelerated angina. Serial ECGs and cardiac enzymes ruled out a myocardial infarction. He had undergone coronary artery bypass grafting 4 years before, as well as coronary stenting of an ostial circumflex lesion 1 year after his bypass. After the procedure, he was doing well until his most recent presentation to us. Diagnostic coronary angiography documented severe native coronary artery disease with in-stent restenosis of the previously stented circumflex artery. A focal lesion was noted at the ostium of the large first septal p...

Iodixanol and Chronic Kidney Disease

Gilbert Deray, MD

Dear Editor,

I read with great interest the Tadros, et al. article1 entitled Iso-osmolar Radiocontrast Iodixanol in Patients with Chronic Kidney Disease (J Invasive Cardiol 2005;17:211–215).

They concluded that the volume of iso-osmolar radio contrast does not affect the incidence of contrast-induced nephropathy (CIN) in diabetic patients with chronic kidney disease. They also compared the incidence of CIN with the use of iso-osmolar contrast iodixanol compared to a similar historical control, and found a lower incidence of CIN with the former (57% versus 24%).

Alt...

February 2006

Richard E. Shaw, PhD, FACC, FACA
Editor-in-Chief

Dear Readers,

This issue of the Journal of Invasive Cardiology includes several interesting research articles, commentaries and selections from the Journal’s special sections, Adjunctive Therapy, Pediatric Intervention, and Clinical Images. Our February case reports can be found on www.invasivecardiology.com. I encourage you to visit our online version to read the informative articles we have chosen to complete this issue.

The first research article by Dr. Shaun Senter and associates from Rush University, provides their cost analysis of embolic complicati...

Refractory Coronary Vasospasm following Drug-Eluting Stent Placement Treated with Cyproheptadine

Adel El-Bialy, MD, Michael Shenoda, MD, Chris Caraang, MD

Over the years, there have been many implicated mechanisms in the pathogenesis of coronary vasospasm. Some of these have included the release of endothelin by vascular endothelial cells,1 loss of endothelial-dependent relaxation following angioplasty,2 local modification of vessel wall arachidonate metabolism after angioplasty3 and serotonin-induced adrenergic dysfunction. More recently, the release of serotonin from aggregating platelets following endothelial damage has been shown to play an important role in the regulation of coronary arterial tone.

Case Report....

Editorial Staff
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    Laurie Gustafson
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    Jeff Benson
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