Volume 19 - Issue 11 - November, 2007
Recurrent Coronary Stent Thromboses and Myocardial Infarctions
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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
Comparison of Multiple Drug-Eluting Stent Percutaneous Coronary Intervention and Surgical Revascularization in Patients with M
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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
Clinical Utility of TandemHeart® for High-Risk Tandem Procedures: Percutaneous Balloon Aortic Valvuloplasty followed by Comple
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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
Treatment of Restenotic Drug-Eluting Stents: An Intravascular Ultrasound Analysis
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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
Myocardial Infarction during Pregnancy: Whose Responsibility?
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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
Extended Stenting of Distal Left Main Coronary Artery for the Treatment of Branch Ostial Disease — Belling the Cat or Bearding
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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,
Distal Side Branch Entry Technique to Accomplish Recanalization of a Complex and Heavily Calcified Chronic Total Occlusion
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Percutaneous intervention of chronic total occlusions (CTOs) can improve exercise capacity, symptoms and left ventricular function.1 The parallel wire technique is a useful technique in recanalizing CTOs.2 This technique utilizes a second wire to cross into the true lumen, while leaving the initial wire in a dissection plane or false lumen.2 The initial wire is used as a guide for where not to cross, and also may act to occlude the entry point to the false lumen, thereby improving chances of true luminal wiring. The bilateral/contralateral injection techniqu
Isolated Disease of the Ostium Left Anterior Descending or Circumflex Artery: Management Using a Left Main Stenting Technique.
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Treatment of isolated coronary stenoses involving the ostium of the left anterior descending (LAD) or circumflex (LCX) artery is challenging for the interventionalist. Although focal stenting is often attempted, it may result in incomplete lesion coverage or protrusion of the proximal stent margin into the ostium of the adjacent vessel. Furthermore, plaque shift with compromise of the adjacent vessel is a potential complication.1,2 Because of these concerns, many patients with this type of disease are referred for coronary artery bypass graft surgery (CABG).
Since compromise
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