Volume 18 - Issue 8 - August, 2006

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

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

Brachytherapy for Renal Artery In-Stent Restenosis

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

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

Axial Plaque Redistribution after Coronary Stent Deployment

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

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

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

Anomalous Right Coronary Artery Originating from the Left Anterior Descending Artery

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

Guidewire Entrapment during Jailed Wire Technique

Several techniques are used to treat coronary bifurcation lesions. One of the commonly used techniques is the jailed wire technique, which is performed by inserting two guidewires into both the main and side branches of a coronary artery. When the main branch is stented, the side branch wire is jailed between the stent and the wall of the proximal main branch. One difficulty with the technique is wire withdrawal. There are no reports in the literature describing a broken jailed wire between two overlapping stents.

Case Presentation. A 72-year-old male had undergone a coronary ang

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