Volume 18 - Issue 12 - December, 2006

To Close or Not To Close? PFO, Sex and Cerebrovascular Events

Toby Ferguson, MD, Lauren H. Sansing, MD, Howard Herrmann, MD, Brett Cucchiara, MD

The precise role of patent foramen ovale (PFO) in causing stroke remains controversial. Clinical factors felt to support a diagnosis of paradoxical embolization through a PFO include presence of concurrent deep vein thrombosis (DVT) and onset of symptoms with a Valsalva maneuver.1 Regarding the latter, sexual activity may be an often unrecognized Valsalva equivalent. The occurrence of stroke during sexual intercourse, therefore, may have important etiologic implications. We describe two cases of cerebrovascular events associated with sexual activity and strongly suggestive of parado...

Late Stent Thrombosis Mimicking Focal Restenosis after Sirolimus Stent Implantation: Angiographic and Intravascular Ultrasound A

Carlos Fernandez-Pereira, MD, Gaston Rodriguez-Granillo, MD, Alfredo E. Rodriguez, MD, PhD

Since the introduction of drug-eluting stents (DES) during interventional procedures, several randomized studies have demonstrated a significant reduction in coronary restenosis and target vessel revascularizations.1–4 However, despite the availability of long-term data, the safety of these devices remains an open question. Coronary stent thrombosis, not detected in the first series, has been recently reported in patients treated with DES.5 Furthermore, two controlled studies reported a higher incidence of subacute and late stent thrombosis with DES compared to bare-met...

Ostial RCA Intervention: Guiding Catheter Challenges and Use of a Buddy Wire to Perform Focused-Force Angioplasty on a Severely

Farrukh Hussain, MD, FRCPC, Tarek Kashour, MD, Mahadevan Rajaram, MD

Case Report. A 67-year-old female presented to our catheterization laboratory with a recent history of unstable angina for 3 weeks. Her cardiac markers were normal. Her past history was significant for diabetes, hyperlipidemia, hypertension and obesity. She subsequently underwent stress testing at another hospital, which was strongly positive. The paieint was therefore referred for angiography.
The left main coronary artery was unremarkable and the left anterior descending vessel had mild disease only. A small-caliber first obtuse marginal had a tight ostial lesion and the circumfle
...

Percutaneous Treatment of a Large Coronary Aneurysm with a Ball Thrombus: An Interventional Challenge

Babu Kunadian, MBBS, MRCP, Andrew R. Thornley, MB, MRCP, Mark A. de Belder, MA, MD, FRCP

A coronary artery aneurysm is defined as a coronary artery dilatation greater than 1.5 times the diameter of either the normal adjacent segments or the diameter of the patient’s largest coronary vessel.1,2 The prevalence varies from 0.3% to 4.9% among patients undergoing coronary angiography with a male preponderance.1 The true prevalence may be lower, as only one-third of angiographically diagnosed aneurysms have the intravascular ultrasound (IVUS) appearance of a true or false aneurysm.3 The most common site for a coronary aneurysm is the right coronary ar...

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
Editor-in-Chief

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...

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