Volume 18 - Issue 3 - March, 2006

Drug-Eluting Stent Strut Distribution: A Comparison between Cypher™ and Taxus® by Optical Coherence Tomography

Recent studies have shown that the use of drug-eluting stents (DES) to deliver antiproliferative agents directly to the vessel wall dramatically reduces the rate of restenosis. However, differences among stent designs, drug delivery vehicles, and choices of pharmacologic agents can significantly affect the safety and efficacy of each device. Thus, focused study on the various constituents of delivery platforms, including the stent backbone, materials used as drug delivery vehicles and the physicochemical properties of the pharmacotherapeutic agents themselves is indicated.1,2 In add



Industry Round Table: Where Are the New Devices?

Brian Firth (Cordis Corporation): As you all probably know, Cordis, in its entirety, is a cardiovascular device company, and now a combination drug/device company. There are four major divisions: 1) Cordis Cardiology, 2) Cordis Endovascular, 3) Biosense-Webster, which focuses on rhythm detection and management, and 4) Cordis Neurovascular, which focuses on intracranial issues. Cordis has just added a stroke group which operates across Johnson & Johnson and coordinates all of the company’s stroke activities. Sam Liang, who was vice president of marketing at Cordis Cardiology for many



Impact of Diabetes on Five-Year Outcomes after Vein Graft Interventions Performed Prior to the Drug-Eluting Stent Era

While an increasing proportion of the grafts used during coronary artery bypass (CABG) procedures are arterial, the majority of grafts implanted at most centers have been and continue to be saphenous vein grafts. On long-term follow up, up to 50% of such vein grafts may be occluded.1,2 Consequently, a significant number of patients with previous CABG eventually require percutaneous coronary intervention (PCI) of diseased vein grafts. Compared to native coronary arteries, saphenous vein grafts (SVG) have a higher plaque burden and are more likely to have lesions that are diffuse, con



Successful Occlusion of Multiple Pulmonary Arteriovenous Fistulae Using Amplatzer® Vascular Plugs

Pulmonary arteriovenous fistulae, or malformations (PAVMs), are congenital or (rarely) acquired abnormal vascular connections between a pulmonary artery and a pulmonary vein. The fistula itself is typically a thin-walled aneurysmal vascular structure that tends to increase over time. Patients with this condition may be asymptomatic, with the diagnosis being suggested by the presence of a persistently abnormal image in the lung fields on repeat chest radiograms. Others present with symptoms such as cyanosis, dyspnea, high output heart failure, hemoptysis and paradoxical embolization.1–3<



The Evolving Role for a Left Ventricular Assist Device in High-Risk Percutaneous Coronary Interventions

In this issue of the Journal, Biswajit Kar, et al. report their initial experience using the TandemHeart Percutaneous Ventricular Assist Device (CardiacAssist, Inc., Pittsburgh, Pennsylvania) in patients who were undergoing a high-risk percutaneous coronary intervention (PCI). The authors chose patients who were at risk for hemodynamic collapse during the PCI. These patients had an unprotected left main stenosis or the equivalent, and were not considered to be candidates for cardiac surgery because of their multiple medical comorbidities.
The TandemHeart is a left ventricular a



Spontaneous Dissection of the Left Coronary Tree after an Interruption of Pregnancy Treated with Extensive Stenting

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden death. It typically occurs in healthy women during the peripartum period or in the presence of connective tissue disorders.1–4 Although the lesion is often fatal and the diagnosis established postmortem, in recent years there have been reports of successful medical, percutaneous and surgical interventions.5 We describe a case of an extensive spontaneous left coronary artery dissection that led to cardiogenic shock and that was successfully treated with multiple stent



“You Can’t Keep a Good Man (or Woman) Down”

There has been an impressive decrease in the incidence of vascular complications following cardiac catheterization in recent years;1 however, excess bleeding from the access site, hematoma, arteriovenous fistula and arterial pseudoaneurysm formation continue to lengthen patients’ hospital stay and affect morbidity. After diagnostic left heart catheterization from the femoral artery, hemostasis has traditionally been achieved through manual compression with the fingertips over the arterial pulse. Many operators act on anecdotal evidence when determining the duration of patient bed



Early Systemic Device Embolization after Transcatheter Patent Foramen Ovale Closure

Percutaneous patent foramen ovale (PFO) closure is a treatment option for secondary prevention in patients with paradoxical embolism. Several procedural and postprocedural complications have been reported with the use of transcatheter techniques. Early device embolization after initial satisfactory implantation for PFO occlusion has been collected in the literature, but often with little detail concerning site, delay, clinical impact and potential causes of this complication.1,2 We report a case of asymptomatic PFO occluder device embolization into the descending aorta observed 24 h



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