Volume 19 - Issue 9 - September, 2007

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...

Primary Percutaneous Coronary Intervention in Saphenous Vein Grafts: A Visualization Strategy to Improve Outcome with New Uses f

Mark S. Patterson, MRCP, MSc, Azad Ghuran, MD, Gert Jan Laarman, MD, PhD

Percutaneous revascularization of diseased saphenous vein bypass grafts (SVGs) remains a difficult challenge for the interventional cardiologist despite major advances in catheter-based reperfusion therapies, adjunctive pharmacology and stent technology. Primary percutaneous coronary intervention (PCI) to SVGs has lower rates of TIMI 3 flow after PCI in the range of 70.2–80.7% as compared to 92–97.4% in native vessels.1,2 This reduced short-term success rate is consistently associated with sustained poor long-term results with increased 1-month,3 6-month...

Vascular Complications in Women after Catheterization and Percutaneous Coronary Intervention 1998–2005

Robert J. Applegate, MD, Matthew T. Sacrinty, MPH, Michael A. Kutcher, MD, Talal T. Baki, MD,
Sanjay K. Gandhi, MD, Frederic R. Kahl, MD, Renato M. Santos, MD, William C. Little, MD

Women have been shown historically to have a greater risk of complications than men following invasive procedures.1–5 The increased incidence of complications in women appears to occur independently of other factors known to influence the incidence of complications after invasive procedures.6–8 Moreover, in the past several years, multiple reports have indicated that women also experience a higher incidence of vascular complications after cardiac catheterization (CATH) and percutaneous coronary interventional (PCI) procedures.9–14 Whether h...

Stent Undersizing Can Result in Procedure-Related Very Late Stent Thrombosis

Steve Ramcharitar, MRCP, DPhil, Jurgen Ligthart, BSc, Willem J. Van der Giessen, MD, PhD

Stent thrombosis is rare, but very serious, with potentially fatal consequences following percutaneous coronary intervention (PCI). Traditionally, it has been classified as acute, within 48 hours, subacute up to 30 days, and late, corresponding to all cases after day 30. Acute or subacute stent thrombosis is often thought to be procedure- or lesion-related, as suggested by data from randomized studies and large registries having fairly similar rates (1–2%) between both bare-metal stents (BMS) and drug-eluting stents (DES).1–3 Late stent thrombosis (LST) with DES remai...

XX and Risky Business

Jacob Green, MD and Peter Block, MD

There is extensive literature demonstrating a disturbingly higher mortality rate, intraprocedural coronary artery injury rate and periprocedural vascular complication rate in women versus men. The disparity has been partially explained by more comorbid disease, older age, smaller size and higher prevalence of hypertension, diabetes, peripheral vascular disease and more severe angina at presentation. Furthermore, it has been suggested that smaller vessel diameters associated with smaller body size have been a driving force for the observed higher rates of both coronary and entry-site vascula...

Multivessel Acute Coronary Thrombosis and Occlusion — An Unusual Cause of Cardiogenic Shock

Yoav Turgeman, MD, Khaled Suleiman, MD, Shaul Atar, MD

Coronary angiography in the early phase of ST-elevation acute myocardial infarction (STEMI) usually identifies total thrombotic occlusion of a single infarct-related artery.1 However, simultaneous acute occlusion of all major epicardial coronary arteries is extremely unusual.2 We present a case of STEMI and cardiogenic shock associated with multiple large thrombi treated successfully by thrombus aspiration and balloon inflations.

Case Report. A 44-year old physician was transferred urgently to our catheterization unit 3 hours after a ...

Outlook of Drug-Eluting Stent Implantation for Unprotected Left Main Disease: Insights on Long-Term Clinical Predictors

Sabine Vecchio, MD, §Tania Chechi, MD, *Guido Vittori, MD, £Giuseppe G.L. Biondi Zoccai, MD,
*Alessio Lilli, MD, *Gaia Spaziani, MD, *Gabriele Giuliani, MD, §Elena Falchetti, MD,
§Massimo Margheri, MD

Unprotected left main coronary artery (LMCA) is one of the most challenging lesion subsets for interventional cardiologists, and is still considered a strict surgical indication as long-term results of recent randomized trials are awaited.

Although no adequately powered randomized comparisons have yet been completed, many registries have assessed the feasibility and safety of LMCA revascularization with bare-metal stents (BMS),1–4 particularly in good surgical candidates with a low EuroSCORE (an established means to predict early mortality in patients undergoing card...

Editorial Staff
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    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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