Volume 19 - Issue 9 - September, 2007

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

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

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

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

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.

Postocclusion Hyperemia Provides a Better Estimate of Coronary Reserve than Intracoronary Adenosine in Patients with Coronary Ar

The physiologic effects of the majority of coronary artery stenosis cannot be determined accurately by conventional angiographic approaches.1,2 Coronary flow reserve3,4 (CFR), and, more recently, fractional flow reserve5 (FFR) have been proposed for assessment of the functional consequence of coronary lesions and evaluation of coronary angioplasty efficiency.6,7 In addition, CFR is a useful tool for the diagnosis of coronary microvascular disease.8,9 Because FFR is the ratio of maximal flow in a stenotic vessel to maximal flow without s

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

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

Secrets of Success in Unprotected Left Main Intervention: Patient and Lesion Selection

Despite advances in percutaneous coronary intervention techniques over the last two decades, the unprotected left main has largely remained the domain of cardiovascular surgery. The subset of patients with left main disease in the Collaborative Study in Coronary Artery Surgery (CASS) study demonstrated superior outcomes with bypass surgery as compared with medical therapy.1 While percutaneous intervention of the unprotected left main artery has been reported as early as in the late 1980s, initial results with balloon angioplasty of the left main were poor, with 1-year mortal

Comparative Intravascular Ultrasound Analysis of Ostial Disease in the Left Main versus the Right Coronary Artery

The aorto-ostial junction has high elastic fiber content with significant elastic recoil.1-7 Ostial left main coronary artery (LMCA) stenoses have larger lumen areas with less plaque burden and more negative remodeling than non-ostial LMCA stenoses. Most ostial LMCA stenoses have been categorized as eccentric and less calcified.8 The RCA ostium shows a lack of arterial distensibility and excessive rigidity, presumably because it contains highly elastic rigid tissue.1,7 Both the LMCA and RCA ostia may have similar morphologic characteristics. However, there i

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

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

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