Volume 18 - Issue 8 - August, 2006

Aortocoronary Dissection with Acute Left Main Artery Occlusion: Successful Treatment with Emergent Stenting

Joanna J. Wykrzykowska, MD, Joseph Carrozza, MD, Roger J. Laham, MD

Case Report. A 65-year-old female with a past history of hypertension, hyperlipidemia, distant tobacco use and coronary artery disease (CAD) presented to an outside hospital with chest pain. Upon arrival to the emergency department, she developed ventricular fibrillation and was promptly defibrillated. Initial electrocardiography (ECG) showed 1 mm ST-segment elevations in leads I and aVL, with inferior ST-segment depressions. The patient was transferred to our hospital for urgent cardiac catheterization. Angiography revealed three-vessel coronary artery disease with thrombus at the...

Anomalous Right Coronary Artery Originating from the Left Anterior Descending Artery

Mazullah Kamran, MD and Monika Bogal, MD

The incidence of an anomalous coronary artery is approximately 1% in the general population. An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is very rare, and has previously been considered a variant of a single coronary artery. We report a unique case of an anomalous right coronary artery originating from the left anterior descending artery. The anomaly was discovered incidentally. Cardiac catheterization was performed for preoperative evaluation of coronary anatomy in a patient with severe mitral regurgitation due to endocarditis. It is particu...

Myocardial Bridging Confined To the Right Ventricular Branch of the Right Coronary Artery in a Patient with Severe Pulmonary Hy

Turgay Celik, MD, Atila Iyisoy, MD, Hurkan Kursaklioglu, MD

Myocardial bridges (MBs) are recognized angiographically by the characteristic narrowing of the coronary lumen occurring predominantly during systole.1–4 The incidence of angiographically-proven MB is between 0.5–12%.2,3 Although MBs are mostly confined to the left anterior descending coronary artery (LAD),1,4 several cases of right coronary artery (RCA) myocardial bridge have been reported in the literature.5–8
Most of the MBs seen in pathological examinations are invisible on angiography because only the deep type of bridges may be apparent ...

Axial Plaque Redistribution after Coronary Stent Deployment

Atsushi Hirohata, MD, Yasuhiro Honda, MD, Peter Fitzgerald, MD, PhD

Axial plaque redistribution (plaque shift) is recognized as one of the acute complications during percutaneous coronary intervention, sometimes resulting in additional procedures. Lumen encroachment after coronary intervention often looks ambiguous and is difficult to evaluate by angiography. Various potential factors, such as plaque redistribution, focal spasm, dissection, hematoma, thrombus or focal deposit of calcium, may be the reason for angiography’s limitations in elucidating this phenomenon. On the other hand, intravascular ultrasound (IVUS) can easily distinguish encroachment and pr...

Brachytherapy for Renal Artery In-Stent Restenosis

Raed Aqel, MD, Ritesh Gupta, MD, Gilbert Zoghbi, MD

Percutaneous transluminal angioplasty (PTA) and stent placement in the renal artery is a safe and effective procedure for the treatment of atherosclerotic renal artery stenosis (RAS). It has been shown to result in reduction of blood pressure and medication requirement in patients with renovascular hypertension.1 However, up to one-fifth of patients receiving PTA and stenting for RAS develop in-stent restenosis (ISR).2
Treatment of ISR in renal arteries remains a challenge with restenting and angioplasty, especially in patients who have aggressive disease. Intravascular...

A Complex Case of Right Coronary Artery Chronic Total Occlusion Treated by a Successful Multi-Step Japanese Approach

Giampaolo Niccoli, MD, *Masahiko Ochiai, MD, Mario Attilio Mazzari, MD

A growing body of evidence suggests a prognostic and symptomatic benefit of reopening coronary chronic total occlusions (CTOs).1 However, percutaneous revascularization of CTOs remains a challenge for the interventional cardiologist. The main limitations of CTO angioplasty were considered to be, on the one hand, difficulty in crossing and, on the other hand, poor angiographic and clinical outcome when using a bare-metal stent (BMS) after occlusion crossing and balloon dilatation.2 The introduction of the drug-eluting stent (DES) has clearly reduced angiographic restenosi...

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...

Editorial Staff
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