Volume 14 - Issue 4 - April, 2002

Predictors of Recurrent Restenosis After Coronary Stenting: An Analysis of 197 Patients

In recent years, coronary stent placement has become an established treatment for patients with coronary artery disease.1,2 However, in-stent restenosis has been reported to occur in 20–30% of patients, and the restenosis rate after treatment for in-stent restenosis is also high (> 30%), regardless of treatment modalities, including balloon angioplasty,3–5 rotational atherectomy,6,7 and repeat stenting. The effectiveness of stent therapy can be questioned, particularly in patients with recurrent restenosis after stent implantation. If the factors for recurrent restenosis can be predicted a

Spontaneous Coronary Artery Dissection in a Young Woman Precipitated by Retching

Spontaneous coronary artery dissection (SCAD) is a relatively rare entity that has been associated with a high morbidity and mortality.1 Although a precise definition for SCAD has not been universally accepted,2 it has generally been defined as the occurrence of a coronary dissection in the absence of trauma, aortic dissection or iatrogenic causes such as coronary angiography or angioplasty.3,4 Cases of SCAD are often associated with one of several different clinical profiles and/or precipitating events. Most cases have been described in young, otherwise healthy women who are often pregnant or

Spontaneous Dissection of Bilateral Internal Mammary Arterial Grafts

Arterial graft dissection is a rare complication of cardiac catheterization. Spontaneous dissection has not been previously described. We report a case of a 49-year-old male with quadruple bypass grafts who presented with acute myocardial infarction due to spontaneous dissection of both internal mammary artery grafts.

Case Report. A 49-year-old white male with 1-year status post-quadruple coronary artery bypass grafting, hypertension and hyperlipidemia presented to the Emergency Department with severe angina at rest. He was a current smoker but denied any drug use. His medications included

Myocardial Injury After Apparently Successful Coronary Stenting With or Without Balloon Dilation: Direct Versus Conventional Ste

Direct stenting (DS) without balloon predilation is a novel approach in the percutaneous treatment of coronary artery lesions. This approach, besides reducing aggression to the vessel wall, may also significantly lower the rate of procedural ischemic complications because the dissections created by balloon inflation are immediately sealed by the endoprosthesis. Stenting without balloon dilation may decrease trauma, incidence of dissection and distal embolization, leading to a better outcome.1–4

Cardiac enzymes troponin T, troponin I, creatine kinase (CK) and its isoform CKMB are particula

Iliac Artery Stenosis Causing Post-Renal Transplant Hypertension: Successful Management by Percutaneous Angioplasty and Stent Im

Renal transplantation offers the potential for complete rehabilitation in end-stage renal disease (ESRD).1 However, as renal transplant recipients survive longer and become an increasingly more elderly population, occlusive atherosclerosis leading to ischemic heart disease and/or peripheral vascular complications is becoming a force with which to reckon. Atherosclerotic occlusion involving the aorto-iliac system can mimic renovascular hypertension in renal transplant recipients and is an important cause of renal dysfunction in this population.2 Poorly controlled hypertension after renal transp

Incremental Progress? The Roles of Direct Stenting and Routine Troponin Measurement After Percutaneous Coronary Intervention

In this issue of the Journal, Timurkaynak et al. raises some important, but not easily resolvable, issues that deserve thought by practicing interventional cardiologists. In this small, observational study measuring cardiac enzymes after PCI, troponin T was found to be elevated somewhat more frequently in patients undergoing predilatation than those undergoing direct stenting. The authors call for further evaluation of the potential merit of the strategy of direct stenting and also suggest further study of the relevance of troponin elevations after PCI.

See Timurkaynak et al. on pages 167

Primary Stenting in a Patient with Acute Myocardial Infarction and Primary Antiphospholipid Syndrome

Antiphospholipid syndrome (APS) is an uncommon thrombotic disorder characterized by antiphospholipid antibodies (aPL). The syndrome may be associated with arterial or venous thrombosis, thrombocytopenia, recurrent fetal loss, skin lesions, neurological complications and retinal occlusion.1 Premature myocardial infarction may also be seen as a part of APS. In coronary artery bypass graft (CABG) operations and coronary balloon angioplasty (PTCA), APS may lead to complications such as bypass graft closure2 and early failure of PTCA.3,4 Although the patients with APS frequently have positive lupus

Aqueous Oxygen Hyperbaric Reperfusion in a Porcine Model of Myocardial Infarction

Hyperbaric oxygen (HBO) administered during reperfusion has been shown experimentally to reduce tissue injury associated with ischemia/reperfusion of a wide variety of tissues,1–8 including myocardium. Potential mechanisms include inhibition of leukocyte adherence; improvement of microvascular flow; reduction of edema; and quenching of lipid peroxide radicals.9 However, implementation of such treatment is not practical for many patients in the acute coronary setting.

We recently developed a new method for delivery of oxygen, based on the infusion of aqueous oxygen (AO) into blood.10,11