Volume 18 - Issue 8 - August, 2006

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

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

Can the Rhythm Method Reduce Stroke after PFO Closure?

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

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

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

Toxic Vessel Reaction to an Absorbable Polymer-Based Paclitaxel-Eluting Stent in Pig Coronary Arteries

Drug-eluting stents (DES) have significantly reduced restenosis. One of the most intensely studied agents considered and currently in clinical use for DES-based local delivery is paclitaxel. Efficacy of paclitaxel-loaded, biostable polymer-coated stents with polymer-based sustained-release, low- and moderate-dose drug delivery for reducing in-stent neointima has been shown in several animal models, including rat, rabbit and pig.1–5
These and other seminal animal studies have demonstrated the dose-dependent response of paclitaxel as a locally delivered antiproliferative agent. Tox

Assessment of the Transvalvular Pressure Gradient in Aortic Stenosis

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

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

Treatment of Stent-Jailed Side Branch Stenoses with Rotational Atherectomy

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

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