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Volume 19 - Issue 9 - September, 2007

Late Angiographic Stent Thrombosis (LAST): The Cloud Behind the Drug-Eluting Stent Silver Lining?

Jack P. Chen, MD

The widespread popularity of drug-eluting stents (DES) had a dramatic impact on the modern interventional therapy of coronary artery disease; accordingly, the cardiac surgical volume has experienced a corresponding decrease. Like the introduction of bare-metal stents (BMS) during the balloon angioplasty era, DES represent yet another quantum advancement towards overcoming the challenges of restenosis. The promises of this potential panacea, however, have been recently attenuated by the looming specter of late angiographic stent thrombosis (LAST). The usual time frame for stent thrombosis is...

Right Pulmonary Artery-to-Left Atrial Fistula: A Differential Diagnosis of Cyanosis without Structural Heart Disease

*Nair Krishnakumar, DM, §Manohar R. Krishna, MCH, *J.A. Tharakan, DM

Direct communication between the right pulmonary artery and the left atrium is an unusual variation of a pulmonary arteriovenous fistula. In fact, there are only about 50 cases reported in the literature.1 This is one condition in which clinical examination may reveal only cyanosis. Contrast echocardiography may show only right-to-left shunt, and only angiography is truly diagnostic.1

Case study. A 19-year-old male presented to us with a history of recently detected cyanosis. His systemic saturation was 81%, with conjunctival congesti...

Of Octopus Pots and Broken Hearts

Jack P. Chen, MD

To the Editor:

The angiographic finding of noncritical coronary stenoses in the setting of acute coronary syndrome and even myocardial infarction has been well described. One potential etiology is Prinzmetal’s angina or coronary spasm.1 More recent Japanese literature, however, has described the so-called “octopus fishing pot”, or takotsubo cardiomyopathy, which refers to the distinctive left ventricular silhouette. The distinctive apical ballooning with basal hypercontractility resembles that of the pot used by Japanese fishermen for trapping octopi....

Endovascular Repair of a Carotid Pseudoaneurysm with Fluency® Plus Stent Graft Implantation

*Carlo Briguori, MD, PhD, §Lucio Selvetella, MD, §Maria Pia Baldassarre, MD

Pseudoaneurysm formation is a rare complication following carotid endarterectomy (CEA), with an incidence of less than 1% of cases.1 Treatment of this complication is challenging. The current standard of care is some form of repair rather than conservative management. Open surgical repair has long been the treatment of choice.2 Recently, endovascular techniques have offered a less invasive approach. We report a case of pseudoaneurysm following CEA treated by percutaneous Fluency® Plus (Bard Peripheral Vascular, Tempe, Arizona) stent graft implan...

Percutaneous Treatment of Severe Carotid Stenosis Due to Takayasu’s Arteritis Early after Carotid Endarterectomy

aLisa Emmans, MD, bTri M. Nguyen, MD, bNathan Laufer, MD

Takayasu’s arteritis (TA) is a chronic inflammatory large-vessel disease of unknown etiology involving the aorta, its major branches and the pulmonary arteries.1,2 Resultant mixed areas of stenosis, occlusion, thrombosis and/or dilatation may cause a variety of symptoms including hypertension, congestive heart failure, mesenteric ischemia and claudication. Involvement of the supra-aortic branches may lead to visual changes including blindness, transient ischemic attacks (TIAs) and cerebral vascular accidents (CVAs). Predominantly a disease of women in the second and third d...

Percutaneous Coronary Intervention of a Totally Occluded Anomalous Right Coronary Artery Arising from the Left Sinus of Valsalva

Christos Graidis, MD, Dimokritos Dimitriadis, MD, Nikolaos Chamouratidis, MD

Coronary arterial anomalies occur in approximately 1% of the population, without other congenital cardiac malformations.1 The incidence of anomalous origin of the right coronary artery out of the right sinus of Valsalva ranges from under 0.01–0.09%. It usually arises from the left sinus of Valsalva or the ascending aorta above it, and in most reported cases, it courses between the great vessels. Rarely, the anomalous origin is found to be from the posterior sinus or another coronary artery. If the anomalous vessel has significant atherosclerotic disease requiring percutaneo...

Contact Wire Technique: A Possible Strategy for Parallel Wire Techniques

*Takamatsu Horisaki, MD, §Jean-François Surmely, MD, *Takahiko Suzuki, MD

Successful recanalization of chronic total occlusion (CTO) improves left ventricular function1 and survival.2 There are, however, several difficulties with percutaneous coronary intervention (PCI) for CTO (CTOPCI). Failure to cross the occlusive lesion with a guidewire is the main cause of unsuccessful CTO-PCI.3,4 The parallel wire technique is common and useful for CTO-PCI.5 However, the parallel wire technique has some limitations, especially for tortuous CTO morphology. In order to manage tortuosity or acute bending, we employ the “contact wire tech...

Sirolimus-Eluting Stent Thrombosis Several Years after Clopidogrel Discontinuation

Dominique Joyal, MD and Lawrence Rudski, MD

Despite meta-analyses showing either similar rates or only slightly increased rates of stent thrombosis in patients with a drug-eluting stent (DES),1–5 clinicians remain concerned about the risk of late stent thrombosis in these patients. It is a uncommon phenomenon that rarely occurred in the previous bare-metal stent era. Late stent thrombosis, with its new set of proposed standard definitions from the Academic Research Consortium (ARC), is now a real clinical problem, regardless of what the initial clinical trials or industry-sponsored postmarketing registries show. Almo...

Percutaneous Closure of Patent Foramen Ovale for Refractory Hypoxemia after HeartMate II Left Ventricular Assist Device Placemen

*Navin K. Kapur, MD, §John V. Conte, MD, *Jon R. Resar, MD

During the fourth week of gestation, the primitive atrium divides into right and left atria by forming two septa, the septum primum and secundum. As the septum primum grows from the dorsocranial wall, two openings develop, the foramen primum at the level of the endocardial cushions, and the foramen secundum at the mid-septal level. As the septum primum fuses with the endocardial cushions, the foramen primum is obliterated. During the fifth and sixth weeks of gestation, the septum secundum develops from the ventrocranial wall of the primitive atrium and overlaps the foramen secundum, leaving...

Towards an Understanding of the Role of Rescue Angioplasty for Failed Fibrinolysis: Comparison of the MERLIN, RESCUE and REACT T

Babu Kunadian, MBBS, MRCP, Kunadian Vijayalakshmi, MBBS, MRCP, Joel Dunning, MRCS, PhD,
Andrew Sutton, MA, MD, MRCP, Mark A. de Belder, MA, MD, FRCP

Early restoration of infarct-related artery (IRA) blood flow and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (MI) is linked with preservation of left ventricular function, myocardial salvage and a reduction in mortality.1 Although primary percutaneous coronary artery intervention (PPCI) is superior to hospitaldelivered thrombolytic treatment, the latter remains the firstline therapy in 30–70% of cases worldwide.1–3 However, thrombolytic therapy fails to restore full patency of the IRA (TIMI grade 3 flow) in up to 5...

Editorial Staff
  • Executive Officer
    Laurie Gustafson
  • Production
    Elizabeth Vasil
  • National Account Manager
    Jeff Benson
  • Senior Account Director
    Carson McGarrity
  • Special Projects Editor
    Amanda Wright
Editorial Correspondence
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