Volume 20 - Issue 4 - April, 2008

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...

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

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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

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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- ...

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