Volume 20 - Issue 2 - February, 2008
Complex Right Subclavian Artery Dissection during Diagnostic Cardiac Catheterization
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Management of vascular complications remains an important component of both diagnostic cardiac catheterization and percutaneous coronary intervention. We report a unique case of extensive right subclavian artery dissection following attempted diagnostic cardiac catheterization of a right internal mammary artery (RIMA) coronary bypass graft. This resulted in complex dissection of the right subclavian artery involving the origin of the right vertebral and internal mammary arteries, as well as critical right upper limb ischemia. Therapy consisted of both conservative management of the proximal
Using Quality Improvement Methods to Improve Door-to-Balloon Time at an Academic Medical Center
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An estimated 500,000 patients per year in the United States1 experience a ST-elevation MI (STEMI) with a shortterm mortality rate of 5–10%.2 Percutaneous coronary intervention (PCI) is the preferred approach for treating STEMI1 and timely reperfusion in patients with STEMI has been shown to increase the likelihood of survival.3 Time-toreperfusion is commonly measured by door-to-balloon time, which measures the time between a patient’s arrival at the hospital to when a balloon is inflated in the coronary artery. Door-to-balloon time for
Treatment of High-Burden Thrombus in a Large Right Coronary Artery
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Case Report. A 30-year-old male with no previous medical history presented to an emergency department at a community hospital with left-sided, substernal chest pain. The pain was pressure-like and nonradiating. It began shortly after performing weight-lifting activity and lasted for more than 2 hours. In the emergency department, the patient was initially treated medically with aspirin and intravenous nitroglycerin, resulting in partial relief of the chest pain.
The patient was hemodynamically stable and physical examination, including cardiac auscultat
Prophylactic, Standby, or Rescue Support for High-Risk PCI: Who Knows?
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This series from Mount Sinai Hospital extends the reported experience with prophylactic deployment of a percutaneous transseptal cardiopulmonary bypass system during high-risk elective coronary angioplasty. These highly experienced operators employed a dual-“preclose” technique in the majority of patients, implanting arterial sutures before pump deployment that permitted immediate postprocedure arterial closure. The short-term outcome was excellent, reported complications minimal, and intermediate-term outcomes reasonable for the high-risk patient cohort described.
How sh
Double Balloon Angioplasty for Unstentable Large-Caliber Right Coronary Stenosis
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Despite newer lower-profile stent technologies, placing coronary stents may still remain challenging when vessels are extremely tortuous. We describe a case of a very large-caliber right coronary artery (RCA) with a “shepherd’s crook” configuration, which could not be stented, and for which double balloon angioplasty was successfully performed.
Case Report. A 69-year-old Caucasian male was hospitalized for an acute coronary syndrome. Diagnostic heart catheterization revealed a 90% eccentric stenosis past the genu of the right coronary artery. The
Effects of B-Type Natriuretic Peptide (Nesiritide) on Coronary Epicardial Arteries, Systemic Vasculature and Microvessels
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Nesiritide (Natrecor®, Scios Inc., Fremont, California) is a recombinant form of human B-type (brain) natriuretic peptide (BNP) that has beneficial vasodilatory, diuretic and neurohormonal effects.1 It activates membrane-bound guanylyl cyclase A-receptor, resulting in accumulation of intracellular cGMP, which in turn mediates the vasodilatory effects in vascular smooth muscle cells.23 Nesiritide is manufactured from E. coli using recombinant DNA technology with a molecular weight of 3,464 g/mol with the same 32 amino acid sequence as th
Twin Circumflex Arteries: A Rare Coronary Artery Anomaly
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Case Report. A 62-year-old Caucasian male presented with recurring angina. He was experiencing angina attacks on walking 10 to 20 yards. The patient had suffered a myocardial infarction in the past and had undergone percutaneous intervention to his left anterior descending artery (LAD). Following the procedure, he remained relatively angina-free until recently. He was diabetic and hypertensive. There was a strong family history of premature coronary artery disease. He was unable to perform an exercise stress test due to peripheral neuropathy. In view of a positive
Use of Radiofrequency Energy and Covered Stents in Patients with an Occluded Superior Vena Cava and Requiring Endocardial Pace
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Obstructions of the caval veins may develop in various clinical settings in subjects with tumoral lesions, after surgery on the caval veins — as in the Mustard/Senning operation, after radiation therapy, or due to central lines, dialysis catheters and pacing wires.1–4 In particular, patients with a history of multiple cardiac surgical procedures or with a history of infections of the pacemaker site and electrodes may easily develop an iatrogenic occlusion of the venous access.2 Various kinds of interventions have been performed in these subjects, including
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