Volume 19 - Issue 11 - November, 2007

Extended Stenting of Distal Left Main Coronary Artery for the Treatment of Branch Ostial Disease — Belling the Cat or Bearding

Deepak Jain, MD

Besides the inherent risk involved in an angioplasty of a major vessel supplying a large myocardial area, percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) branch ostial disease is fraught with some unique problems, namely, high elastic recoil, excessive plaque burden, plaque shift or plaque redistribution, melon-seeding effect, calcification, retrograde dissection of the left main or the other major branch artery, and the technical challenge of a very precise stent placement when attempting the conventional focal stenting of the affected branch ostium. The stent,...

Myocardial Infarction during Pregnancy: Whose Responsibility?

Jesus G. Mirelis, MD, Jose Antonio Fernandez-Diaz, MD, Javier Goicolea, MD


Case Report. A 37-year-old female in her seventh week of pregnancy presented to the emergency department after the onset of oppressive chest pain which had started 1 hour before. Her 8 previous pregnancies had terminated in abortion. She had no cardiovascular risk except for smoking, nor a history of alcohol or drug abuse. Her father had died of Leriche’s syndrome. A history of untreated peripheral obstructive arteriopathy was reported.
Clinical examination showed obesity. The patient was afebrile. Her blood pressure was 140/100 mmHg with a pu
...

Treatment of Restenotic Drug-Eluting Stents: An Intravascular Ultrasound Analysis

Koichi Sano, MD, PhD, Gary S. Mintz, MD, Stephane G. Carlier, MD, PhD, Emilia Solinas, MD,
Jose de Ribamar Costa Jr., MD, Jie Qian, MD, Eduardo Missel, MD, Shoujie Shan, MD,
*Theresa Franklin-Bond, MS, PA, *Paul Boland, BS, Giora Weisz, MD, Issam Moussa, MD,
George Dangas, MD, PhD, Roxana Mehran, MD, Alexandra J. Lansky, MD, Edward Kreps, MD,
Michael Collins, MD, Gregg W. Stone, MD, Jeffrey W. Moses, MD, Martin B. Leon, MD

Sirolimus-eluting and paclitaxel-eluting stents decrease neointimal hyperplasia leading to a reduction, but not elimination, of in-stent restenosis.1–4 Because sirolimus and paclitaxel decrease neointimal hyperplasia, restenosis is dependent on final drug-eluting stent (DES) dimensions; an optimally expanded stent area assessed by intravascular ultrasound (IVUS) is a strong predictor of freedom from clinical, angiographic and IVUS restenosis after DES implantation.5–9 However, it is not possible to obtain an optimum stent area in all lesions, and it is not ...

Clinical Utility of TandemHeart® for High-Risk Tandem Procedures: Percutaneous Balloon Aortic Valvuloplasty followed by Comple

Sanjay Rajdev, MD, Adil Irani, MD, Samin Sharma, MD, Annapoorna Kini, MD

Percutaneous left ventricular (LV) assist devices are increasingly being used during high-risk percutaneous coronary interventional (PCI) procedures.1–4 These devices provide reliable short-term hemodynamic stability in complex cases during which the interventionist has the luxury of time to successfully carry out the procedure. The TandemHeart® (Cardiac Assist, Inc., Pittsburgh, Pennsylvania) is a relatively recent introduction to the available percutaneous nonpulsatile centrifugal LV assist devices that can be used to support poorly functioning ven...

Comparison of Multiple Drug-Eluting Stent Percutaneous Coronary Intervention and Surgical Revascularization in Patients with M

Elisabetta Varani, MD, Marco Balducelli, MD, Giuseppe Vecchi, MD, Matteo Aquilina, MD,
Aleardo Maresta, MD

Since the introduction of drug-eluting stents (DES) in clinical practice, it has become clear that percutaneous revascularization of multivessel coronary artery disease (CAD) could be more effective in terms of event reduction (major adverse cardiac events [MACE] and target vessel revascularization [TVR]) and become comparable to surgery. Results of randomized, controlled trials of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with progressively more complex lesions1–4 have confirmed the very good clinical and angiographic results of the first studies...

Recurrent Coronary Stent Thromboses and Myocardial Infarctions

Jack Chen, MD and Angampally Rajeev, MD

Case Report. A 64-year-old male was transferred from an outside facility after sustaining a non-ST-elevation myocardial infarction (STEMI). Cardiovascular risk factors included noninsulin- dependent diabetes mellitus and hypertension. Additionally, his past medical history was significant for a stent placed in the left anterior descending artery in the remote past, as well as bladder cancer status post cystectomy 5 months prior and chemotherapy completion a few weeks ago. He was hemodynamically stable and symptom-free at the time of admission to ou...

Multivessel PCI versus CABG: One-Year Outcomes and Cost Analysis

Jithendra Choudary, MD, Imran Arif, MD, Tarek Helmy, MD

Optimal revascularization strategy for patients with multivessel coronary artery disease has been, and remains, a topic of controversy. Rapid technological advances in percutaneous coronary interventions (PCI) such as the introduction of new devices and highly maneuverable stents have made it possible to attempt complex lesions with great procedural success rates. Furthermore, drug-eluting stents (DES) offered about a 50% decrease in restenosis, reducing the need for repeat revascularization, which has been the Achilles heel of PCI. Surgical techniques have also evolved over the past severa...

Multivessel PCI versus CABG: One-Year Outcomes and Cost Analysis

Jithendra Choudary, MD, Imran Arif, MD, Tarek Helmy, MD

Optimal revascularization strategy for patients with multivessel
coronary artery disease has been, and remains, a topic
of controversy. Rapid technological advances in percutaneous
coronary interventions (PCI) such as the introduction of new
devices and highly maneuverable stents have made it possible
to attempt complex lesions with great procedural success
rates. Furthermore, drug-eluting stents (DES) offered about a
50% decrease in restenosis, reducing the need for repeat
revascularization, which has been the Achilles heel of PCI.
Surgical techniques have also evolved over the past ...

Percutaneous Aortic Valve Replacement: New Hope for Inoperable and High-Risk Patients

Helen C. Routledge, MD, Thierry Lefèvre, MD, Marie-Claude Morice, MD,
Federico De Marco, MD, Lynda Salmi, MD, Bertrand Cormier, MD

Aortic stenosis is the most common valvular heart disease in the Western world and its prevalence is increasing with an aging population. Critical aortic stenosis affects an estimated 3% of individuals over 75 years of age.1 Without intervention, progressive disability due to symptoms of angina, syncope or heart failure ensues, and survival rarely exceeds 2 to 3 years. Currently, surgical aortic valve replacement is the only treatment that offers both symptomatic and prognostic benefit. In patients who are declined cardiac surgery, physicians have little to offer. The search for ...

Consensus Update on the Appropriate Usage of Cardiac Computed Tomographic Angiography

Moderators: a,§Michael Poon, MD and b,*Geoffrey D. Rubin, MD
Panelists: cStephan Achenbach, MD, dTim W. Attebery, MD, eDaniel S. Berman, MD,
fThomas J. Brady, MD, gJill E. Jacobs, MD, hHarvey S. Hecht, MD, iJoão A.C. Lima, MD,
jWm. Guy Weigold, MD

Introduction and Purpose

The consensus statement outlined here was formulated following a roundtable meeting among clinical experts in the fields of radiology and cardiology held in Miami, Florida, in June 2007. This group was gathered under the auspices of two key specialty societies supporting the field of computed tomographic angiography (CTA): the Society of Cardiovascular Computed Tomography (SCCT) and the North American Society for Cardiac Imaging (NASCI).
The purpose of the roundtable meeting was to produce an updated consensus on CTA’s utility and ...

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