Volume 19 - Issue 7 - July, 2007
Interatrial Septal Defect Closure for Cerebrovascular Accidents: Exploring the Role of Various Anticoagulants
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Interatrial septal defects (IASD) have been associated with an increased incidence of cryptogenic strokes.1–7 Percutaneous closure of these defects is now widely performed and the safety of this procedure has been established. It is unclear, however, which is the best anticoagulant to use during IASD closure. Bivalirudin has been shown to have lower bleeding complication rates in patients undergoing percutaneous coronary intervention.8–12 These patients involved primarily an arterial access in contrast to percutaneous closure of IASD that primarily involves
Similar Case of Anomalous Origin
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I read the article regarding a single coronary artery by Namboodiri et al,1 published in the April 2007 issue of the Journal of Invasive Cardiology, with great interest. However, the authors missed referencing a few important publications related to their article. I had already reported a similar case of anomalous origin of the left anterior descending artery (LAD) from the right coronary sinus having a septal course, absence of a left circumflex artery (LCx), and an unusual dominant course of the right coronary artery (RCA) in the International Journal of Cardiology in June of 2005
Transcatheter Closure of Small-to-Large Patent Ductus Arteriosus with Different Devices: Queries and Challenges
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Patent ductus arteriosus (PDA) can cause congestive cardiac failure, repeated pneumonia, pulmonary hypertension and an increased risk for endocarditis. Transcatheter closure of PDA is currently the preferred therapeutic alternative to surgical ligation1–3 in infants, children and adults. During the last decade, clinical experience has widened extensively and several occlusive devices have been used for this purpose. These include Rashkind’s double umbrella, the Sideris buttoned device, Gianturco spring coils, Cook’s detachable coils and, most recently, the Ampla
Carotid Artery In-Stent Restenosis Resolved with Drug-Eluting Stenting
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We were pleased to have our Clinical Decision Making article “Carotid Artery In-Stent Restenosis in a Patient with Contralateral Total Occlusion, Resolved with Drug-Eluting Stenting” published in the June 2007 issue of the Journal of Invasive Cardiology (2007;19:275–279). We are particularly compelled to respond to Dr. Nanjundappa’s commentary on our case. We had considered, as Dr. Nanjundappa did, that restenosis in this case was not a benign process. It was clear that this was a true restenosis, as reflected by the velocities on Doppler examinatio
Percutaneous Closure of Patent Ductus Arteriosus: State of the Art
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Patent ductus arteriosus (PDA) may be an isolated lesion or may be present in association with other defects. Isolated PDA constitutes 6–11% of all congenital heart defects. The configuration of PDA varies considerably, but most often it has a conical or funnel shape. The aortic end (ampulla) is wide and gradually narrows towards the pulmonary end. The narrowest segment is usually at the pulmonary end. PDA morphology can vary and the ductus may be short and tubular, have multiple constrictions, or have a bizarre configuration. Some order was brought to classifying the PDAs by the work
Difficult Anatomies: Use Three Hands
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Today’s interventional cardiologist is armed with a vast array of devices for treatment of increasingly difficult lesions. Inhospitable anatomies previously considered suitable only for surgical therapy are now frequently accessible with modern tools and techniques. Extra back-up guiding catheters as well as extra-support guidewires provide solid platforms for device delivery. “Buddy wires” help to deflect stents from vessel wall calcifications while the Wiggle Wire (Guidant Corp., Indianapolis, Indiana) actually allows the stent to bounce away from potential obst
Prolonged Dual Antiplatelet Therapy after Percutaneous Coronary Intervention Reduces Ischemic Events without Affecting the Need
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When clopidogrel is added to background aspirin therapy, it reduces the composite of cardiovascular death, myocardial infarction (MI) or stroke in patients with acute coronary syndromes (ACS)1 or percutaneous revascularization.2 The most consistent reduction is observed in MI and lasts for at least 1 year after initiation of therapy. Because dual antiplatelet therapy with aspirin and thienopyridines also reduces the incidence of acute and subacute stent thrombosis,3,4 it may be construed that the reduction in adverse ischemic events is the resul
Percutaneous Treatment of Catheter-Induced Dissection of the Right Coronary Artery and Adjacent Aortic Wall
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Acute aortic dissection during coronary arteriography or percutaneous coronary intervention is quite rare,1,2 but is a feared complication. Patients in this clinical setting may have a potential risk for acute myocardial infarction (MI) requiring emergency surgery.3 Awareness of the problem and its prompt recognition are essential and the possibility of such a complication should be kept in mind when the patient develops severe chest pain during angioplasty. Still, there remains a paucity of data regarding the risk factors and management of aorto-coronary dissection. <
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