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... continue reading about Spontaneous Coronary Artery Dissection in a Young Woman Precipitated by Retching
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.
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
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... continue reading about Iliac Artery Stenosis Causing Post-Renal Transplant Hypertension: Successful Management by Percutaneous Angioplasty and Stent Im
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.
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... continue reading about Primary Stenting in a Patient with Acute Myocardial Infarction and Primary Antiphospholipid Syndrome
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.
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 ... continue reading about Editor’s Message
Transcatheter closure of a small patent ductus arteriosus (PDA) is now an established treatment in many pediatric cardiology centers. As for occlusion of large PDA, interventional cardiologists are still looking for a simple, but safe and effective procedure. There are several reports using various devices and novel techniques for occlusion of large PDA.1–5 Although the procedures are effective approaches, some use expensive devices and some require exquisitely complex techniques. The increased costs and technical difficulty prevent their widespread use by interventional cardiologists.