Volume 18 - Issue 2 - February, 2006

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....

Procedural Success and 30-Day Outcomes between CYPHER™ and TAXUS® Stent Implantation for the Treatment of Bifurcation Lesions —

Chi Hang Lee, MD, Huay Cheem Tan, MD, Hwee Bee, MD, Jun Jie Zhang, MD, Chao Yang Soon, MD, Swee Guan Teo, MD, Adrian Low, MD, Yean Teng Lim, MD

CYPHER™ (sirolimus-eluting stent, Cordis, Johnson and Johnson, Miami, Florida) and TAXUS® (polymer-based paclitaxel-eluting stent, Boston Scientific Corporation, Natick, Massachusetts) stents are the two drug-eluting stents (DES) currently approved by the Food and Drug Administration (FDA) for clinical use. Both DES have been proven effective in reducing the risks of restenosis and repeat revascularization in simple coronary lesions.1,2
There are fundamental differences between the CYPHER and TAXUS stents, including the drug coatings, polymers and stent platforms. ...

Refractory Hypoxemia after Mitral Valve Surgery: An Unusual Cause and Its Successful Percutaneous Treatment

Alexander Sirker, MD, Jonathan Hyde, MD, David Hildick-Smith, MD

A variety of approaches are used for mitral valve repair and replacement operations. Rare complications specific to the surgical method may need to be considered if patients encounter unexplained problems postoperatively. We discuss such an example here. The operative approach to the mitral valve in this case was transseptal (from the right atrium), a method which has been widely used as an alternative to the more frequently employed left atriotomy.1,2 There are certain situations in which the transseptal approach may be particularly useful — for example, allowing better visualiza...

Bifurcation Intervention: Keep it Simple

James B. Hermiller, MD

The percutaneous treatment of bifurcation lesions remains suboptimal. A frequent problem, accounting for 10–20% of coronary lesions undergoing percutaneous coronary intervention (PCI), the bifurcation is plagued by acute technical challenges, long-term restenosis, and more recently, early and late stent thrombosis.1–4 Generally defined as a lesion which involves a side branch of 2.0 mm or greater, the bifurcation is in part so complex due to its variability. This variability results from inconsistent plaque distribution, unpredictable side branch angulation and large differences...

Fibromuscular Dysplasia and Acute Myocardial Infarction: Evidence for a Unique Clinical and Angiographic Pattern

Jose F. Huizar, MD, Ashish Awasthi, MD, Hani Kozman, MD

Myocardial infarction (MI) typically occurs in the setting of atherosclerotic coronary artery disease (CAD). However, there are other causes of MI unrelated to atherosclerosis that include spontaneous dissection of the coronary arteries, anomalous origin of coronary arteries, vasculitis, toxins such as carbon monoxide, medications (5-fluorouracil, sumatriptan, ergotamine) and hypercoagulable states.1–7 Fibromuscular dysplasia (FMD) is a condition typically involving small and medium-sized vessels. It has been rarely described in coronary arteries at autopsy8–13 in ass...

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