Volume 20 - Issue 2 - February, 2008

Bifurcation Coronary Artery Disease: Current Techniques and Future Directions (Part 1)

Published randomized trials of drug-eluting stents (DES) have shown reduced rates of restenosis and target lesion revascularization (TLR) in noncomplex lesions compared to bare-metal stents (BMS).1 Given this documented success of the antiproliferative therapies in relatively simple lesions, interventional cardiologists have developed techniques and devices hoping to demonstrate similarly durable results in more complex lesion subsets.2–6 Bifurcation coronary artery disease (CAD) comprises an important subset of lesions inadequately studied and thus far unapproved f



Clinical Application of Prophylactic Percutaneous Left Ventricular Assist Device (Tandem Heart™) in High-Risk Percutaneous Cor

Introduction of novel devices for cardiac support during complex percutaneous coronary intervention (PCI) has revolutionized the treatment of coronary artery disease (CAD) and has led to an increasing number of high-risk PCI procedures. Traditionally, the intra-aortic balloon pump (IABP) has been used to provide hemodynamic stability during coronary interventions in high-risk patients. However, the mortality rate continues to be high (30–75%) despite the use of IABPs in the setting of acute myocardial infarction complicated by cardiogenic shock; insertion of a percutaneous transseptal



Two-Year Clinical Follow Up of Coronary Drug-Eluting Stent in Patients at High Risk for Coronary Restenosis

Drug-eluting stents (DES), compared with bare-metal stents (BMS), have shown a clear superiority in the prevention of restenosis and the need for further revascularization in randomized, controlled trials.1–5 Accordingly, the superiority of DES over BMS was confirmed in large registries.6,7 A major finding regarding the use of DES is that although the safety of DES is not different from that of BMS in the shortto- medium term, concern has arisen about the potential for late stent thrombosis related to delayed endothelialization of the stent struts.8,9



High-Dose, Bolus-Only, Glycop rotein IIb/IIIa Inhibitors for Elective Coronary Intervention: Logical, Safe, Cost-Effective, an

Platelet-mediated thromboembolic events are believed to cause the majority of non-Q-wave myocardial infarctions (MI) observed after an otherwise uncomplicated percutaneous coronary intervention (PCI).1
Activation of the platelet-surface glycoprotein IIb/IIIa (GP IIb/IIIa) receptor is the final common pathway in the process leading to platelet aggregation, and thrombus formation after PCI.1,2 The use of weight-adjusted bolus, plus prolonged infusion of IIb/IIIa inhibitors has been shown to reduce the risk of non-Q-wave MI (CPK-MB leaks) after PCI.3–9



Occlusion of a Sano Shunt Using the Amplatzer Duct Occluder

Many centers are currently adopting the Sano modification of the Norwood operation for infants with hypoplastic left heart syndrome.1 The insertion of a right ventricle-to-pulmonary artery conduit may increase aortic diastolic pressure and coronary artery perfusion.2 In the face of an unexpectedly elevated pulmonary vascular resistance prior to the bidirectional Glenn operation, an additional source of pulmonary blood flow may be required. This situation may arise either intraoperatively, prohibiting shunt takedown, or postoperatively, requiring reoperation and s



High-Dose Tirofiban Administered as Bolus-Only during Percutaneous Coronary Intervention

Inhibition of platelet glycoprotein IIb/IIIa receptors during percutaneous coronary intervention (PCI) using tirofiban, eptifibatide and abciximab has been associated with improved outcomes.1 The only head-to-head comparison to these agents was provided by the “do Tirofiban And Reopro Give similar Efficacy outcomes Trial (TARGET)”, in which patients were randomized to tirofiban or abciximab.2 In this study tirofiban offered less protection from major ischemic events compared to abciximab. However, the dose of tirofiban used in the TARGET trial (bolus of 10



Primary Cardiac Diffuse, Large B-Cell Lymphoma in an Immunocompetent Patient

Primary cardiac non-Hodgkin’s lymphoma is defined as being exclusively located in the heart and/or pericardium, and is extremely rare. This disease occurs mainly in immunocompromised patients and rarely in the immunocompetent. In a series of over 12,000 autopsies, only 7 primary tumors were identified for an incidence of less than 0.1%.1 Primary cardiac lymphoma comprises only 2% of all cardiac tumors, and may obstruct valvular orifices and even cause hypertrophic cardiomyopathy when heavy tumorous lesions infiltrate the ventricular septum, as described by Roberts et



February 2008

This issue of the Journal of Invasive Cardiology includes original research articles, a review article, selections from the journal special section Clinical Images and online case reports which can be found in the archive section on our website, as well as in the new Digital JIC at: www.invasivecardiology.com. I encourage you to visit the website to read these interesting and informative case reports.
In the first research article, submitted by Dr. Robert Huang and colleagues from the Vete



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