Volume 14 - Issue 4 - April, 2002

Extensive Right Coronary Artery Dissection Following Cutting Balloon Treatment of In-Stent Restenosis

Giampaolo Niccoli, MD, William P. Orr, MD, Adrian P. Banning, MD

Case Description. A 44-year-old female was readmitted with chest pain on minimal exertion. She was an ex-smoker and had hypercholesterolemia. Eight months previously, she had experienced an episode of unstable angina and underwent coronary angiography, which demonstrated an essentially normal left coronary artery and a critical stenosis of the proximal right coronary artery. This was stented directly with a 3.5 x 15 mm NIR Royal stent (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota). She was discharged on aspirin and clopidogrel for one month and was well until pain recurred three mont...

Risk Stratification in Patients with Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Evidence-Based Review

Rami Doukky, MD and James E. Calvin, MD

Unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) are closely related clinical syndromes; they are often undistinguishable at presentation, and often entail similar early diagnostic and therapeutic approach. Unstable angina is defined as: 1) angina that occurs at rest or with minimal exertion; 2) new onset angina (within one month) with Canadian Cardiovascular Society Classification III or IV in severity; or 3) worsening previously stable angina. First attempts in evaluating UA were directed toward ruling out myocardial infarction (MI).1–5 More modern approaches consid...

Extensive Right Coronary Artery Dissection Following Cutting Balloon Treatment of In-Stent Restenosis

Giampaolo Niccoli, MD, William P. Orr, MD, Adrian P. Banning, MD

Case Description. A 44-year-old female was readmitted with chest pain on minimal exertion. She was an ex-smoker and had hypercholesterolemia. Eight months previously, she had experienced an episode of unstable angina and underwent coronary angiography, which demonstrated an essentially normal left coronary artery and a critical stenosis of the proximal right coronary artery. This was stented directly with a 3.5 x 15 mm NIR Royal stent (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota). She was discharged on aspirin and clopidogrel for one month and was well until pain recurred three mont...

Management of Dissection and Other Complications: Spontaneous Coronary Artery Dissection in a Young Woman Precipitated by R

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...

Late-Term Myocardial Infarction After Surgical Ligation of a Giant Coronary Artery Fistula

Steven L. Goldberg, MD, *Joel Manchester, MD, **Hillel Laks, MD, **Joseph Perloff, MD

Large coronary artery fistulae have been associated with complications such as congestive heart failure, myocardial ischemia, endocarditis, rupture and arrhythmias.1 To reduce the risk of complications, large coronary artery fistulae are often treated with surgical ligation or percutaneous device closure. Because this is an uncommon malformation, there is little information on outcomes after interventions, and there may be under-reporting of late-term complications. We report a case of recurrent myocardial infarction occurring after successful surgical closure of a giant coronary artery fistul...

Management of Dissection and Other Complications – 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 ...

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 ...

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