Volume 20 - Issue 4 - April, 2008

April 2008

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

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J INVASIVE CARDIOL 2008;20:E97-E101

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



Percutaneous Coronary Intervention in Neurosurgical Patients

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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

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

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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



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

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



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

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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



Stent Thrombosis – A Complication Best Avoided

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.



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