Volume 18 - Issue 8 - August, 2006

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...

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...

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