Volume 18 - Issue 8 - August, 2006

Frequency and Determinants of “Black Holes” in Sirolimus-Eluting Stent Restenosis

Jose de Ribamar Costa Jr., MD, Gary S. Mintz, MD, Stéphane G. Carlier, MD, PhD, Kenichi Fujii, MD, Koichi Sano, MD, Masashi Kimura, MD, PhD, Kaoru Tanaka, MD, PhD, Joanna Lui, BA, MD, Jeffrey W. Moses, MD, Martin B. Leon, MD

In-stent restenosis is the result of neointimal hyperplasia that, by intravascular ultrasound (IVUS) imaging, typically has a homogeneous, echoreflective appearance. Histological and immunohistochemical analyses of “typical” in-stent neointimal hyperplasia tissue have shown spindle-shaped mesenchymal cells (a-actin-positive smooth muscle cells) with very little collagen and elastin.1–3 Clinically, brachytherapy has reduced recurrent in-stent restenosis,4–6 and sirolimus-eluting stent (SES) implantation has reduced first-time in-stent restenosis.7–9 Ho...

Side-Strut Stenting Technique for the Treatment of Aorto-Ostial In-Stent Restenosis and Deformed Stent Struts

Jason M. Burstein, MD, Tony Hong, BSc, Asim N. Cheema, MD, PhD

Percutaneous coronary interventions of aorto-ostial lesions, de novo or restenotic, are technically difficult and associated with a higher risk of procedural complications and poor long-term outcome.1–4 To reduce elastic recoil and improve long-term patency, coronary stenting is routinely employed for aorto-ostial lesions and accomplished by placing a stent across the coronary ostium with the proximal stent segment protruding into the aorta to allow complete lesion coverage. Repeat intervention on an aorto-ostial stent for the treatment of in-stent restenosis poses unique challeng...

Treatment of Stent-Jailed Side Branch Stenoses with Rotational Atherectomy

*Robert T. Sperling, MD, Kalon Ho, MD, §David James, MD, Roger Laham, MD, Michael Gibson, MD, Joseph Carrozza, MD

Percutaneous intervention of coronary ostial stenoses carries a lower procedural success rate and a higher likelihood of acute complication and need for repeat revascularization. Technical challenges related to the treatment of ostial side branches include smaller vessel size, an angulated orientation of the side branch relative to the parent vessel, vascular recoil and plaque shifting into the parent vessel in response to balloon angioplasty. Stents that have been placed in the parent vessel across the origin of side branches confer an additional level of complexity to percutaneous treatme...

Feasibility of a Pressure Wire and Single Arterial Puncture for Assessing Aortic Valve Area in Patients with Aortic Stenosis

*Jang-Ho Bae, MD, Amir Lerman, MD, Eric Yang, MD, Charanjit Rihal, MD

Aortic stenosis (AS) is commonly encountered by cardiologists. Assessment of AS is routinely performed with Doppler echocardiography, but cardiac catheterization has an important role in the assessment of patients with inconclusive echocardiographic findings. The basis of invasive assessment is the Gorlin equation, which requires measurement of the transvalvular pressure gradient.1 This gradient can be measured by using the pullback method, but simultaneous assessment of left ventricular pressure and aortic pressure is more accurate.2 To obtain simultaneous pressure measu...

Assessment of the Transvalvular Pressure Gradient in Aortic Stenosis

Ted Feldman, MD

Bae et al describe the use of a pressure wire in conjunction with a 5–6 Fr guiding catheter to measure transvalvular gradients in 18 patients with aortic stenosis.1 The method is clearly technically feasible, and correlated well with echocardiographic estimates of aortic valve area. The quality of the pressure tracings using the pressure wire method is excellent, and is reminiscent of the high-fidelity tracings recorded from multisensor electromagnetic tansducer-tipped catheters.
Challenges in the assessment of aortic stenosis severity. Correlation of echocardiography with...

Frequency of Atrial Tachyarrhythmias following Transcatheter Closure of Patent Foramen Ovale

aJamshid Alaeddini, MD, bGeorges Feghali, MD, bStephen Jenkins, MD, bStephen Ramee, MD, bChristopher White, MD, bFreddy Abi-Samra, MD

Patent foramen ovale (PFO) is a frequent finding in young patients with cryptogenic stroke.1–4 PFO has also been related to migraine,5 platypnea-orthodoxia syndrome (condition in which shortness of breath and hypoxemia occur when upright and resolve when prone),6 and decompression illness in divers.7 Long-term anticoagulation8 and surgical closure of PFO have been used as therapeutic options,9–12 however, their results have been mixed with respect to stroke prevention. Recently, percutaneous transcatheter PFO closure techniques have been used mor...

Can the Rhythm Method Reduce Stroke after PFO Closure?

Peter C. Block, MD

In this issue of the Journal of Invasive Cardiology, Alaeddini et al report on the incidence of atrial tachyarrhythmias (AT) in their series of 71 patients who had closure of a patent foramen ovale (PFO) performed for cryptogenic stroke or orthodeoxia.1 There are many drawbacks to this study, not the least of which is the fact that only patients who complained of palpitations were the ones who were further evaluated by Holter monitoring. In addition, only 48-hour Holter monitoring was performed, rather than longer “event” monitoring, which might have uncovered more AT. He...

Switching from Enoxaparin to Bivalirudin in Patients with Acute Coronary Syndromes without ST-Segment Elevation Who Undergo Pe

Ron Waksman, MD, Roswitha M. Wolfram, MD, Rebecca L. Torguson, BS, Petros Okubagzi, MD, Zhenyi Xue, MS, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD

Recent randomized trials have established that patients who present with acute coronary syndrome (ACS) non-ST-elevation myocardial infarction (MI) may be managed with low-molecular weight heparin (LMWH) followed by early angiography and by appropriate medical management, percutaneous coronary intervention (PCI) or surgery.1–3 Despite the common utilization of the LMWH enoxaparin for the early treatment of patients presenting with ACS, there is still insufficient information available regarding its efficacy and safety when combined with other antithrombotic agents, such as unfracti...

High Incidence of Focal Left Ventricular Wall Motion Abnormalities and Normal Coronary Arteries in Patients with Myocardial Infa

Brian Strunk, MD, Richard E. Shaw, PhD, Sally Bull, RN, James Adams, MD, Margaret Baer, MD, Kent Gershengorn, MD, Ann Kao, MD, Brian Keeffe, MD, Joel Sklar, MD, David Sperling, MD, Robert Sperling, MD, Mark Wexman, MD, Jerald Young, MD

Myocardial infarction with angiographically normal coronary arteries (MINCA) is a well-documented syndrome.1 The incidence of MINCA among all patients with myocardial infarctions is thought to be low, ranging from 1–5%,2–4 as reported from older and often incomplete studies. Recent studies5,6 of patients with MINCA have reported groups, but not the incidence, of patients with an unusual left ventricular wall motion abnormality (LVWMA) called Takotsubo cardiomyopathy,7 a rare condition that was first described in Japan and has been documented more...

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