Volume 14 - Issue 4 - April, 2002

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

Koichi Kishi, MD, Yoshikazu Hiasa, MD, Naoki Suzuki, MD, Hiroshi Miyamoto, MD,
Takefumi Takahashi, MD, Shinobu Hosokawa, MD, Masato Tanimoto, MD, Ryuji Otani, MD

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

Muthu Velusamy, MD, *Mark Fisherkeller, MD, *Michael E. Keenan, MD,
Robert C. Gallagher, MD, Francis J. Kiernan, MD, Daniel B. Fram, MD

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

Ahmad Qaddour, MD and Chanwit Roongsritong, MD

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

Timur Timurkaynak, MD, Murat Ozdemir, MD, Atiye Cengel, MD, Haci Ciftci, MD, Mustafa Cemri, MD, Guliz Erdem, Ridvan Yalcin, MD, Bulent Boyaci, MD, Ovsev Dortlemez, MD, Halis Dortlemez, MD

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

A.S. Mullasari, MD, DM, DipNB, C.V. Umesan, MD, DNB, DM,
N. Radhakrishnan, BSc, MVS, V. Lakshmi, BSc, MPhil

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

Stephen G. Ellis, MD

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

Özer Badak, MD, Sema Güneri, MD, Önder K?r?ml?, MD, Özhan Göldeli, MD,
Özgür Aslan, MD, *Hayri Özsan, MD

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

J. Richard Spears, MD, Cassandra Henney, ATC, PhD, Petar Prcevski, DVM, Rui Xu, MD, Li Li, PhD, Giles J. Brereton, PhD, Marcello DiCarli, MD, Ali Spanta, MD, Richard Crilly, PhD, Abdulbaset M. Sulaiman, MD, Samir Hadeed, MD, Steven Lavine, MD, William R. Patterson, PhD, Jeffrey Creech, PhD, Richard Vander Heide, MD, PhD

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...

Editor’s Message

Richard E. Shaw, PhD, FACC

Dear Readers,

This issue of the Journal of Invasive Cardiology includes several interesting articles. In the first research article, Dr. J. Richard Spears and collaborators from the Cardiovascular Research Laboratory, Wayne State University, TherOx Inc. in Irvine, California and Michigan State University present their preliminary study of aqueous oxygen hyperbaric reperfusion in a porcine model of myocardial infarction. They demonstrate that with their novel approach to catheter-delivered hyperbaric reperfusion of intracoronary aqueous oxygen, myocardial ischemia and reperfusion injury can ...

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