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... continue reading about Late Angiographic Stent Thrombosis (LAST): The Cloud Behind the Drug-Eluting Stent Silver Lining?
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
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.... continue reading about Of Octopus Pots and Broken Hearts
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... continue reading about Endovascular Repair of a Carotid Pseudoaneurysm with
Fluency® Plus Stent Graft Implantation
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... continue reading about Percutaneous Treatment of Severe Carotid Stenosis Due to Takayasu’s Arteritis Early after Carotid Endarterectomy
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... continue reading about Contact Wire Technique: A Possible Strategy for Parallel Wire Techniques
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... continue reading about Sirolimus-Eluting Stent Thrombosis Several Years after Clopidogrel Discontinuation