Volume 20 - Issue 4 - April, 2008

My History of Carotid Angioplasty and Stenting

Jacques Théron, MD

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J INVASIVE CARDIOL 2008;20;E102-E108

My mentor, René Djindjian, one of the fathers of interventional neuroradiology, used to say that it was very difficult to write the history of a technique because one can never satisfy everyone. I agree, thus I will only present here the history of the endovascular treatment of carotid bifurcations based upon my personal experience and my view of its future evolution.
After the fundamental work in endovascular therapy by Charles Dotter1...

A Novel Method of PercuSurge Distal Protection in a Five French Guiding Catheter without an Export Aspiration Catheter

aFuminobu Yoshimachi, MD, PhD, bYuji Ikari, MD, PhD, bTakashi Matsukage, MD, PhD,
cMotomaru Masutani, MD, PhD, dYasuhiro Mori, MD, PhD, eShigeru Saito, MD,
fKen Okumura, MD, PhD

Use of a distal protection device is essential in current percutaneous coronary intervention (PCI) procedures because distal embolization can be avoided with some specific lesions such as vein grafts,1,2 carotid stenoses3,4 and thrombus-rich coronary lesions.5,6 Several types of distal protection devices are available such as distal balloon occlusion, proximal occlusion and filter wire systems. The PercuSurge (PS) (Medtronic, Inc., Minneapolis, Minnesota) is a distal balloon occlusion system that occludes the distal artery during intervention and as...

Transcatheter Device Closure of Atrial Septal Defects in Patients Older than 60 Years of Age: Immediate and Follow-Up Results

*Huda Elshershari, MD, †Qi-Ling Cao, MD, †Ziyad M. Hijazi, MD, MPH

Percutaneous closure of atrial septal defects (ASDs) is a safe procedure and has been routinely performed in many centers around the world as an alternative to surgical closure.1–5 However, in elderly patients with ASD, prolonged left-to-right shunt results in right ventricular volume overload and subsequent pulmonary artery hypertension. Several reports demonstrated the benefits of ASD closure in adults such as the prevention of ongoing congestive heart failure from volume overload, a reduction in pulmonary artery pressure and improvement in symptoms and quality of life. ...

The Declining Relevance of Age in the Treatment of Atrial Septal Defects

Srihari S. Naidu, MD

Atrial septal defects (ASD), which comprise roughly 10% of all congenital cardiac disease, are frequently first encountered in the adult population.1 Significant shunting results in the insidious development of symptoms, culminating in overt heart failure typically in the third to fifth decade of life.2–4 Despite this typically late presentation, management of these defects has historically centered on the belief that early surgical repair during the asymptomatic period prevents progression, improving both the quality and quantity of life. Indeed, the age of 25 year...

Long-Term Outcomes after Intracoronary Beta-Irradiation for In-Stent Restenosis in Bare-Metal Stents

*Micha T. Maeder, MD, *Matthias E. Pfisterer, MD, *Peter T. Buser, MD, §Hans W. Roser, MD,
£Jakob Roth, MD, *Daniel Weilenmann, MD, *Fabian P. Nietlispach, MD, *Michael J. Zellweger, MD,
£Beat Amsler, MD, *Christoph A. Kaiser, MD

Intracoronary brachytherapy using β- or γ-irradiation is effective in reducing angiographic restenosis as well as target vessel revascularization (TVR) in patients with in-stent restenosis (ISR) after bare-metal stent (BMS) implantation.1–5 Today, however, the technique is rarely used due to important logistic demands, the occurrence of stent-edge restenosis, a certain need for late TVR (“late catch-up phenomenon”), and most importantly, the introduction of drug-eluting stents (DES).6 Total occlusion occurring between 6 and 12 months after ...

Percutaneous Transcatheter Left Atrial Appendage Exclusion in Atrial Fibrillation

Paul T.L. Chiam, MBBS, MRCP and Carlos E. Ruiz, MD, PhD

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J INVASIVE CARDIOL 2008;20:E109-E113

Stroke is the third leading cause of mortality in the developed world.1 The incidence of first-ever strokes was > 731,000 in 1996 in the United States alone.2 In addition, stroke is the leading cause of serious disability and morbidity and has devastating consequences, not only on the functional status of affected patients, but also on their family and caregivers.1
Atrial fibrillation (AF) is one of the most common card...

Efficacy of a Novel Procedure Sheath and Closure Device during Diagnostic Catheterization: The Multicenter Randomized Clinical

aAnthony A. Bavry, MD, MPH, aRussell E. Raymond, DO, aDeepak L. Bhatt, MD,
bCharles E. Chambers, MD, cAndrew J. DeNardo, MD, dJames B. Hermiller, MD, ePaul R. Myers, MD,
cDouglas E. Pitts, MD, cJohn A. Scott, MD, fScott J. Savader, MD, gSteven Steinhubl, MD

Multiple devices are currently available for closure of the femoral artery access site after cardiac catheterization.1 Currently, the most widely used closure devices are the Angio-Seal device (St. Jude Medical, St. Paul, Minnesota)2–4 and the Perclose®2,5 and StarClose,2 devices (Abbott Vascular, Redwood City, California). The aim of these devices when compared to manual compression is to safely improve patient comfort, decrease time to hemostasis with earlier ambulation and expedite...

State-of-the-Art Nonvascular Interventions: Mitral Valvuloplasty

Dominique Himbert, MD, Eric Brochet, MD, Bernard Iung, MD, Alec Vahanian, MD

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J INVASIVE CARDIOL 2008;20:E114-E119

Mitral stenosis (MS) is still frequent in many countries where rheumatic fever remains endemic.1–2 In Western countries, since the disappearance of rheumatic fever, it has become infrequent and remains a clinical entity due to immigration and restenosis after surgical commissurotomy. Percutaneous mitral commissurotomy (PMC), which was introduced more than 20 years ago,3 acts similarly to surgical commissurotomy by splitting th...

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

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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...

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