Volume 19 - Issue 10 - October, 2007

Utility of Sirolimus-Eluting Cypher™ Stents to Reduce 12-Month Target Vessel Revascularization in Saphenous Vein Graft Stenoses

aStephen G. Ellis, MD, bDavid Kandzari, MD, cDean J. Kereiakes, MD, dAugusto Pichard, MD,
eKen Huber, MD, fFrederic Resnic, MD, gSteven Yakubov, MD, hKeith Callahan, MPH,
aMarilyn Borgman, RN, i,jSidney A. Cohen, MD, PhD

Approximately 1 million patients are now treated annually in the United States with drug-eluting stents (DES). Usage of these stents is substantiated in many patient and lesion subsets by their documented relative safety and reduction in clinical restenosis in large-scale randomized clinical trials.1,2 Such trials cannot be feasibly performed in all groups of patients. The pathology of atherosclerosis in saphenous vein grafts (SVGs) differs somewhat from that in native coronary arteries, and restenosis after bare-metal stenting (BMS) tends to occur more frequently in the former t...

Late Coronary Stent Infection: A Unique Complication after Drug-Eluting Stent Implantation

Elizabeth Gonda, BA, Allyson Edmundson, BS, RN, Tift Mann, MD

Coronary stent infection is a rare but previously reported complication of coronary artery stenting procedures (CAS).1–13 In the few cases reported in the literature, patients have presented within days to weeks of stent implantation with fever, and the infection presumably was related to periprocedural bacteremia or direct septic stent implantation.14–18

Case Report. A 75-year-old male was seen for stable angina pectoris in June 2005. His past medical history included hypertension, type II diabetes mellitus, hypercholesterolemia...

DES for SVG Stenosis — We All Want to Do It, But Are We There Yet?

Charles S. Smith, MD and Yerem Yeghiazarians, MD

More than 400,000 coronary artery bypass graft (CABG) operations are performed annually in the United States, with the saphenous vein graft (SVG) as the major type of conduit.1 However, surgical revascularization is not definitive, and recurrent angina occurs in 5–10% of patients per year.2 While progression of native coronary atherosclerosis explains some of the symptom recurrence, disease of the grafts is a major problem — over 50% of SVGs are severely diseased or occluded after 10 years.3,4 Because re-do CABG is associated with significant mor...

Adenosine Conditioning and Pacing in Conjunction with Early Intra-Aortic Balloon Pump Use and Glycoprotein IIb/IIIa Inhibition

Farrukh Hussain, MD, FRCPC

Cardiogenic shock complicating myocardial infarction carries a poor prognosis. Data regarding percutaneous intervention in the very elderly with cardiogenic shock is sparse.1 Age is an independent risk factor for worse outcome with cardiogenic shock.1 Few studies or registries include the very elderly with cardiogenic shock.2,3 Improved TIMI (Thrombolysis In Myocardial Infarction) flow post-intervention provides a better outcome in this condition.4 Multivessel intervention is also independently prognostic of a worse outcome in cardiogenic shock. ...

Assessing Intermediate Coronary Lesions: Angiographic Prediction of Lesion Severity on Intravascular Ultrasound

*,§,£Marlos R. Fernandes, MD, MSc, §Guilherme V. Silva, MD, *Adriano Caixeta, MD, PhD,
*Miguel Rati, MD, £Nelson A. de Sousa e Silva, MD, PhD, §Emerson C. Perin, MD, PhD

Conventional angiography is the gold standard in clinical practice for diagnosing atherosclerotic compromise of the coronary artery tree. However, coronary angiography has several known limitations, including a lack of correlation between the percentage of stenosis and the lesion’s physiologic importance1 and considerable interobserver variability in classifying the lesion’s severity.2,3

Intravascular ultrasound (IVUS) has been shown to detect atherosclerotic compromise that cannot be detected by conventional angiography.4 Using tomographi...

Rare Case of Persistent Left Superior Vena Cava to Left Upper Pulmonary Vein: Pathway for Paradoxical Embolization and Develop

*Michael R. Recto, MD, §Henry Sadlo, MD, *Walter L. Sobczyk, MD

The performance of transesophageal echocardiography (TEE) has become common in the routine assessment of patients who have had transient ischemic attacks (TIAs) or stroke. As part of the TEE evaluation, agitated saline is usually injected through a peripheral intravenous (IV) line after which a Valsalva maneuver is performed to determine the presence or absence of right-to-left shunting across a patent foramen ovale (PFO). In our patient, a large volume of microbubbles was first seen in the left atrium. On careful review of the TEE, microbubbles were observed entering the left atrium throug...

Outcomes of Primary Percutaneous Coronary Intervention at a Joint Commission International Accredited Hospital in a Developing

§Fahim H. Jafary, MD, FACC, Hafeez Ahmed, MD, Jawad Kiani, MD

Percutaneous coronary intervention (PCI) is an established therapy for patients with symptomatic coronary artery disease including acute coronary syndromes. In patients presenting with ST-elevation myocardial infarction (STEMI), a considerable body of evidence now suggests that reperfusion with primary PCI provides better short- and long-term outcomes compared to fibrinolytic therapy.1-3 Although widely adopted as the default strategy for patients presenting with STEMI in developed nations, there are virtually no data on the applicability, success and outcomes of primary PCI in t...

“Fogarty-Like” Removal of Large Coronary Thrombus

Carlo Trani, MD, Giuseppe Ferrante, MD, Mario Attilio Mazzari, MD

In patients undergoing emergency percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), several thrombectomy and distal protection devices have been evaluated in order to either remove thrombus and plaque components at the occlusion site, or trap embolic materials, respectively. The effect of thrombectomy devices on myocardial perfusion have been conflicting: some studies1–3 show a benefit, while others suggest a detrimental effect on myocardial salvage resulting in increased infarct size.4 Specifically, unrestricted use of dista...

Reduction in Myocardial Infarct Size by Postconditioning in Patients after Percutaneous Coronary Intervention

§Xin-Chun Yang, MD, §Yu Liu, MD, Le-Feng Wang, MD, Liang Cui, MD, Tie Wang, MD,
Yong-Gui Ge, MD, Hong-Shi Wang, MD, Wei-Ming Li, MD, Li Xu, MD, Zhu-Hua Ni, MD,
Sheng-Hui Liu, MD, Lin Zhang, MD, Hui-Min Jia, MD, *Jakob Vinten-Johansen, PhD,
*Zhi-Qing Zhao, MD, PhD

Timely reperfusion is the most effective intervention to protect the heart from myocardial infarction resulting from coronary occlusion. However, experimental studies and clinical observations have provided strong evidence in support of the existence of reperfusion-induced myocardial injury. Reperfusion injury initiates a series of adverse events that offset the benefits intended by implementing early reperfusion.1–4 Protection elicited by pharmacological treatment applied briefly at the onset of reperfusion may be observed acutely, but may not be evident when the duration ...

Spontaneous Coronary Artery Perforation Secondary to a Sirolimus-Eluting Stent Infection

Ravi K. Garg, MD, James E. Sear, MD, Eric S. Hockstad, MD

From the Section of Cardiology, Research Medical Center, Kansas City Cardiology, Kansas City, Missouri.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted February 28, 2007, provisional acceptance given May 2, 2007, manuscript accepted June 6, 2007.

Address for correspondence: Ravi K. Garg, MD, Section of Cardiology, Research Medical Center, Kansas City Cardiology, 6420 Prospect Avenue, T-509, Kansas City, MO 64132. E-mail: ravi.garg@kchf.org

ABSTRACT: Coronary stent infection is exceedingly rare despite the widespread use of percutaneous coronary intervention (PCI). The utilization of drug-eluting stents (DES) may have a higher theoretical risk of infection due to their local immunosuppressant effect. Vigilance in suspecting stent infection is important, as the associated mortality rate is approximately 50%. We discuss the case of a patient who presented with an infected DES 2 weeks after implantation which led to spontaneous Type II coronary perforation. The perforation was sealed with prolonged balloon inflation,...

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