Volume 20 - Issue 4 - April, 2008

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...

Protection Devices and Thrombectomy for Native Coronary Artery ST-Elevation Myocardial Infarction

*Ronen Gurvitch, MBBS, FRACP, *,§Andrew E. Ajani, MBBS, MD, FRACP, FJFICM, FCSANZ,
*Bryan P. Yan, MBBS, FRACP, £Ron Waksman, MD

Primary percutaneous coronary intervention (PCI) is established as optimal therapy for patients with ST-elevation myocardial infarction (STEMI).1 The goal of primary PCI is to achieve a thrombolysis in myocardial infarction (TIMI) 3 flow and also to restore adequate perfusion at the myocardial level. However, visible thrombus embolization to the distal circulation during primary PCI occurs in up to 14% of patients, and outcomes in these patients are compromised.2 Furthermore, even in patients without such macroembolization, myocardial reperfusion is often suboptimal, w...

Collateral Circulation via a Rare, Anomalously Arising Right Ventricular Branch

*Anil Kumar, MD, §Mohammed Murtaza, MD, §Shahriar Yazdanfar, MD


J INVASIVE CARDIOL 2008;20:E136-E137

Coronary collateral vessels are able to supply blood to a myocardial territory vascularized by severely stenosed or occluded epicardial arteries. They may contribute significantly to the limitation of ischemia and infarct size.1,2 Improvement in left ventricular function3,4 and prevention of left ventricular aneurysm formation5 also has been attributed to the presence of collateral vessels.
Variations in coronary anato...

Cardiac Magnetic Resonance and “Augmented” Right-to-Left Intracardiac Shunting through a Patent Foramen Ovale

Benjamin K. Dundon, MD, Peter J. Psaltis, MD, Stephen G. Worthley, MD, PhD

Platypnea-orthodeoxia is an uncommon condition characterized by the development of hypoxia and breathlessness in the upright posture, relieved by resuming a supine position. It was first described by Altman and Robin in 19691, and has since been associated with intracardiac and intrapulmonary shunts, liver disease and a host of other conditions.2 We report an unusual case of episodic breathlessness and hypoxia cured by percutaneous cardiac intervention.
Case Presentation. An independent 83-year-old male presented with a 6-month history of paroxysmal breathlessness an...

April 2008

Richard E. Shaw, PhD, FACC, FACA

This issue of the Journal of Invasive Cardiology includes original research, a Rapid Communication article, a Review, several case reports, two Clinical Images selections, and articles from the proceedings of the 30th Anniversary of Angioplasty and International Andreas Gruentzig Society meeting. Some of these articles are in this print edition and all are available on our website at www.invasivecardiology.com.
In the first original article, Dr. Anthony Bavry, from the Department of Cardiovascular Medicine at the...

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