Volume 20 - Issue 4 - April, 2008

Vascular Closure Devices: Have We Caught the Right FISH?

*Dominique Joyal, MD and §Robert S. Dieter, MD, RVT

The introduction of vascular closure devices (VCDs) in the mid-1990s has truly made a difference for the interventional cardiologist. Despite a multitude of studies showing either decreased, increased or similar rates of vascular complications, VCDs are used in a large proportion of procedures in the United States.1 The main advantages include decreased time to hemostasis, early ambulation, greater patient comfort and the ability to remove the introducer regardless of anticoagulation status. For the operator, being able to achieve hemostasis immediately without relying on other pers...

Malignancy: An Unrecognized Risk Factor for Coronary Stent Thrombosis?

aAlex R. Hobson, BSc, MRCP, aDaniel B. McKenzie, BMedSci, MRCP,
bVijayalakshmi Kunadian, MBBS, MD, MRCP, bIan Purcell, BSc, MD, MRCP,
cAzfar Zaman, BSc, MD, FRCP, aKeith D. Dawkins, MD FRCP, dNick Curzen, PhD, FRCP


J INVASIVE CARDIOL 2008;20:E120-E123

Stent thrombosis (ST) is an important, life-threatening complication of percutaneous coronary intervention (PCI) and coronary stent placement that has been associated with mortality rates of up to 45%.1 There is currently particular concern regarding the frequency of late ST in PCI patients receiving drug-eluting stents (DES) in whom, despite optimal therapy, the incidence in large “realworld” series remains 0.5–1%.2,3 T...

Short- or Long-Term Outcomes of Coronary Artery Aneurysms Occurring after Directional Coronary Atherectomy

Yuji Oikawa, MD, Junji Yajima, MD, †Dominick J. Angiolillo, MD, PhD, Masafumi Akabane, MD,
Ryuichi Funada, MD, Shunsuke Matsuno, MD, Toshiro Inaba, MD, Yuya Nakagawa, MD,
Michinari Nakamura, MD, Hitoshi Sawada, MD, Tadanori Aizawa, MD

Coronary artery aneurysms (CAAs) represent a relatively uncommon finding in patients who undergo percutaneous coronary intervention (PCI). However, the prevalence of CAAs has been shown to be higher in patients undergoing PCI utilizing directional coronary atherectomy (DCA) in whom CAAs have been observed in up to 10% of patients.1–5 The higher prevalence of CAAs in patients undergoing DCA has led practitioners to question the prognostic implications of the occurrence of this epiphenomenon, which to date still remain uncertain. The aim of the present study was to investiga...

Angioplasty, Stenting and Thrombectomy to Correct Left Main Coronary Stem Obstruction by a Bioprosthetic Aortic Valve

Sofia Thomopoulou, MD, Petros Sfirakis, MD, Konstantinos Spargias, MD


J INVASIVE CARDIOL 2008;20:E124-E125

An infrequent, but potentially lethal, complication after aortic valve replacement (AVR) is the occurrence of iatrogenic coronary ostial stenosis. This complication has been observed after both mechanical and bioprosthetic valve use and its reported incidence varied between 0.3% and 5%.1,2 The most likely pathophysiological mechanism proposed is posttraumatic fibrous intimal proliferation caused by coronary ostia cannulation for direct cardioplegia dur...

Urgent PCI in Patients with Stent Thrombosis: An Observational Single-Center Study Comparing Thrombus Aspiration and Standard

Maria De Vita, MD, Francesco Burzotta, MD, PhD, Carlo Trani, MD, Enrico Romagnoli, MD,
Giovanni Paolo Talarico, MD, Italo Porto, MD, Antonio Maria Leone, MD,
Giuseppe G.L. Biondi-Zoccai, MD, Giampaolo Niccoli, MD, Antonio Giuseppe Rebuzzi, MD,
Rocco Mongiardo, MD, Mario Attilio Mazzari, MD, Giovanni Schiavoni, MD, Filippo Crea, MD

Stent thrombosis (ST) is a recognized complication limiting the clinical efficacy of percutaneous coronary interventions (PCI), the incidence reported being between 0.5% and 2.2%.1–5 Due to the increasing number of stent-based PCI procedures, the absolute number of patients experiencing ST is expected to expand, and the introduction of drug-eluting stents in clinical practice is expected to change the histopathology,6 presentation7 and possibly the incidence of patients with ST.
Despite the evident clinical relevance associated with ST, its manag...

Percutaneous Balloon Valvuloplasty of Coexisting Mitral and Tricuspid Stenosis: Single-Wire, Double-Balloon Technique

Tariq Ashraf, Dip. Card. FCPS, Asad Pathan, MD, Asadullah Kundi, FCPS


J INVASIVE CARDIOL 2008;20:E126-E128

Technique. Percutaneous transmitral commissurotomy (PTMC) was first described by Inoue et al in 1984 as an alternative to surgical closed mitral commissurotomy for severe rheumatic mitral stenosis (MS).1 PTMC is less traumatic, cosmetically more acceptable and its early and mid-term results in selected cases are similar or better than surgical commissurotomy. Two techniques have been established for balloon mitral valvotomy: single- ...

Stent Thrombosis – A Complication Best Avoided

Madan Sharma, MD and Yerem Yeghiazarians, MD

Stent thrombosis (ST), while infrequent, is a serious complication of percutaneous coronary intervention (PCI) resulting in myocardial infarction (MI) or death.1–4 While drug- eluting stents (DES) have reduced the rate of restenosis and target lesion revascularization by 50–70% as compared to baremetal stents (BMS), there have been some concerns regarding ST.5,6,9–12 Systematic reviews of randomized trials revealed no overall differences relative to death with DES during longterm follow up to 5 years, but did show an increase in very late ST with DES....

Successful Recanalization of In-Stent Coronary Chronic Total Occlusion by Subintimal Tracking

Nae Hee Lee, MD, PhD, Yoon Haeng Cho, MD, PhD, Hye Sun Seo, MD


J INVASIVE CARDIOL 2008;20:E129-E132

Percutaneous treatment of coronary chronic total occlusions (CTO) remains one of the major challenges in interventional cardiology. Although CTO in the form of in-stent restenosis (ISR-CTO) is relatively rare, with an incidence of 1.6% of stent procedures, it is associated with significant morbidity.1 The paucity of published data on this rare population indicates that the low success rate of PCI is mostly due to difficulty in passing the guidewi...

B-Type Natriuretic Peptide and Serum Unbound Free Fatty Acid Levels after Contemporary Percutaneous Coronary Intervention

aWarren J. Cantor, MD, bHahn Hoe Kim, MD, cSanjit Jolly, MD, cGordon Moe, MD,
dJason M. Burstein, MD, eAurora Mendelsohn, fAlan M. Kleinfeld, PhD, cDavid Fitchett, MD

B-type natriuretic peptide (BNP) and serum unbound free fatty acid (FFAu) are novel cardiac markers. BNP is a polypeptide secreted by the cardiac ventricles in response to volume and pressure overload. Measurement of BNP levels has demonstrated diagnostic value in heart failure and has evolved to be a powerful prognostic marker in acute coronary syndromes, stable coronary heart disease, diabetes and heart failure.1–3 FFAu is a sensitive marker of myocardial ischemia.4 A previous study conducted prior to the era of routine coronary stenting demonstrated a rise in ...

Percutaneous Coronary Intervention in Neurosurgical Patients

John Thompson Sullebarger, MD, Nancy Wymer, RN, Denise Holloway, ARNP


J INVASIVE CARDIOL 2008;20:E133-E135

The management of coronary disease in patients with spinal or intracranial disease may be challenging. In some cases, coronary lesions may require treatment before neurosurgery, while in others, myocardial ischemia or infarction may occur in the postoperative patient or simultaneously with stroke or intracranial hemorrhage. Patients with subarachnoid and intracranial hemorrhage have a high incidence of cardiovascular complications,1 and antiplatelet an...

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