Volume 20 - Issue 4 - April, 2008

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...

Frugal Coronary Angioplasty, Still an Option after 30 Years

Bernhard Meier, MD



Coronary angioplasty was not the first interventional procedure in cardiology (Table 1), but it clearly launched the discipline called interventional cardiology as we know it today.
Percutaneous coronary intervention (PCI), as it is customarily called today, had a slow start. Three years into its existence, the world experience still totaled less than 1,000 interventions (Table 2). Andreas Grüntzig showed impressively and unmistakably ...

My History of Carotid Angioplasty and Stenting

Jacques Théron, MD


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 ...

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