Volume 18 - Issue 12 - December, 2006

Fibrinolysis and Coronary Stenting for Treatment of an Acute Inferior Myocardial Infarction after Ascending Aortic Aneurysm Repa

Ali H. Shakir, MD, Jaime S. Gomez, MD, *H. Vernon Anderson, MD

Anastamotic complications of the coronary ostia after successful Bentall-type surgery for aortic root replacement have been reported, with an estimated incidence of 5–6%.1 These problems are usually minimized by coronary artery bypass graft surgery. We report a case of a patient with an acute inferior myocardial infarction that developed 18 months after Bentall repair surgery for a type-A aortic dissection, and which was treated with percutaneous coronary stenting.

Case Report. A 64-year-old male previously underwent repair of a type-A aortic dissection. Resection and...

Retrograde-Antegrade Left Main Coronary Artery Stenting

Ricardo I. Vicuna, MD, Paul Silverman, MD, Bruce Abramowitz, MD, FACC, FSCAI

Recurrent ischemic symptoms are the most frequent reason for repeat revascularization in post coronary artery bypass artery (CABG) patients. Of the reported 8% per year of patients who suffer from recurrent ischemia, 5% annually are attributable to the progression of atherosclerosis in the native coronary arteries.1–3
Repeat surgical intervention in this group of patients has been associated with a higher mortality rate than the initial CABG and a documented higher complication rate, lower angina relief4–7 and the risk of compromising a functioning left internal mamm...

December 2006

Richard E. Shaw, PhD, FACC, FACA

Dear Readers,

The December 2006 issue of the Journal of Invasive Cardiology includes original research articles, a continuing medical education offering, articles from the journal’s special sections Clinical Images and Genomics and Cellular Therapy, and seven online case reports which can be found on our website: www.invasivecardiology.com.
In the first research article, Dr. Amir Halkin and colleagues present a study assessing clinical outcomes following percutaneous coronary intervention (PCI) comparing drug-eluting stents (DES) and bare-metal stents (BMS) in dialysis patients u...

Clinical Outcomes following Percutaneous Coronary Intervention with Drug-Eluting vs. Bare-Metal Stents in Dialysis Patients

aAmir Halkin, MD, bFaith Selzer, cOscar Marroquin, MD, dWarren Laskey, MD, bKatherine Detre, aHoward Cohen, MD

Late mortality rates following percutaneous coronary intervention (PCI) among dialysis patients markedly exceed those in patients without end-stage renal disease,1,2 and data preceding the approval and widespread use of drug-eluting stents indicate that PCI compared with surgical revascularization is associated with higher mortality rates in these patients.3 Though drug-eluting stents have been shown to reduce the risk of restenosis in populations consisting predominantly of patients with normal or mildly impaired renal function,4–6 the safety and clinical ef...

COMMENTARY: Bugs and Clots: The Value of Transesophageal Echocardiography in Defining Permanent Pacemaker Lead Infections

Kul Aggarwal, MD and Lokesh Tejwani, MD

The number of patients receiving pacemaker and implantable cardioverter-defibrillator (ICD) implants is rapidly increasing. The number of permanent pacemaker implants in the United States increased from about 95,000 in 1990 to 250,000 in 2002, while the number of ICD implants increased from 10,000 in 1990 to 100,000 in 2002.1
Improvements in resolution and greater utilization of transesophageal echocardiography (TEE) in clinical practice have led to increased detection of abnormalities on implanted leads. The reported incidence of such masses is highly variable, but fortunately app...

Severe, Diffuse Coronary Artery Spasm after Drug-Eluting Stent Placement

Brigitta C. Brott, MD, Andreas S. Anayiotos, PhD, Gregory D. Chapman, MD, Peter G. Anderson, DVM, PhD, William B. Hillegass, MD, MPH

Drug-eluting stents have dramatically changed the care of patients with coronary artery disease, leading to decreased neointimal proliferation and clinical restenosis.1 However, concerns have been raised regarding hypersensitivity reactions.2 In addition, a case of localized hypersensitivity and late coronary thrombosis resulting in death has been described.3 A recently published analysis demonstrates that there is abnormal vasomotion with vasoconstriction during exercise 6 months after Cypher™ stent (Cordis Corp., Miami, Florida) placement compared to...

PCI with and without Abciximab after Upstream Eptifibatide Use: Outcomes in High-Risk Patients

Robert J. Applegate, MD, Mark A. Grabarczyk, MD, David C. Sane, MD, Matthew T. Sacrinty, MPH, Jason E. Goodin, BA, G. Sidney Statonk, MD, Talal T. Baki, MD, Sanjay K. Gandhi, MD, Michael A. Kutcher, MD, William C. Little, MD

Several clinical trials have demonstrated that platelet glycoprotein (GP) IIb/IIIa receptor inhibition reduces the ischemic complications of percutaneous coronary interventions (PCI).1–4 Comparative data between agents, however, are very limited,5 and no large, randomized trials exist comparing the efficacy and safety of the two most commonly used agents, eptifibatide and abciximab. Based on clinical trials demonstrating a clear benefit of abciximab in high-risk patients1,2,4 and a more modest benefit of eptifibatide use in the ESPRIT trial,4 a str...

COMMENTARY: Vasoconstriction and Coronary Artery Spasm after Drug-Eluting Stent Placement

§Mario Togni, MD and *Franz R. Eberli, MD

In this issue of the Journal, Brott et al1 report a series of 13 patients who developed severe, life-threatening coronary artery spasms after implantation of a drug-eluting stent. Symptoms occurred either during or immediately after the procedure or within the first 4 weeks after stent implantation. In 1 patient, vasoconstriction was present in a follow-up angiogram at 1 year. Spasms resolved in most patients after administration of vasodilators, however, 2 patients did not respond to treatment and died. Another 2 patients required placement of an intra-aortic balloon pump for cardi...

GENOMICS AND CELLULAR THERAPY: Successful Mobilization of Peripheral Blood Stem Cells by Use of Granulocyte-Colony Stimulating F

Clemens Steinwender, MD, Christian Gabriel, MD, Franz Leisch, MD

There is increasing evidence that the liberation of stem cells by use of granulocyte-colony stimulating factor (G-CSF) with or without their transcoronary transplantation is feasible and can improve cardiac function in humans after acute myocardial infarction (AMI).1–3 However, patients with severe hemodynamic deterioration due to extensive loss of contractile tissue after AMI have not been enrolled in stem cell programs up to now. We report on the case of a patient with acute anterior wall myocardial infarction who suffered from cardiogenic shock despite successful primary percut...

Troponin-Positive Chest Pain with Unobstructed Coronary Arteries: A Role for Delayed Enhanced Cardiovascular Magnetic Resonance

Nick G. Bellenger, MD, BSc, MRCP, Charles Peebles, MRCP, FRCR, Stephen Harden, RCS, FRCR, Keith Dawkins, MD, FRCP, Nick Curzen, PhD, FRCP, FESC

Acute coronary syndromes represent a significant health burden and convey a prognosis that is far from benign. Indeed, United Kingdom registry data reveal that 6 months following admission for a non-ST elevation myocardial infarction (NSTEMI), there is a 12.2% rate of death or non-fatal MI, and a 30% rate of death, MI, refractory angina or readmission for unstable angina.1 A number of trials have demonstrated that early revascularization has a significant beneficial impact on patients with NSTEMI,2,3,4 prompting international guidelines to recommend early angiography and ...

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