Spontaneous coronary artery dissection (SCAD) is a rare clinical event with little available information on etiology, treatment, or outcomes. Two cases of SCAD are presented and identified cases from the literature with complete data (n = 222) are reviewed and analyzed. Female patients (71.9%) were younger (40.4 versus 46.7; p < 0.001), less likely to have coronary artery disease (3.7 versus 20.6%; p = 0.01), more likely to have left anterior descending artery (46.4 versus 25.4%; p = 0.004) and left main artery involvement (14.9 versus 3.2%; p = 0.01), and less likely to survive (50.9 versus 22.2%; p < 0.001) compared to their male counterparts. Thirty percent were in the peripartum state. Multivariate predictors of death included female sex (OR 4.27; 95% CI 1.50 to 12.2), non-treatment (OR 35.5; 95% CI 10.7 to 118.1), and earlier decade of diagnosis (OR 0.28 per increase in decade after 1980; 95% CI 0.16 to 0.49). Survival was no different by treatment type and did improve over time.

Critical limb ischemia is frequently associated with significant peripheral vascular disease (PVD) below the knee. Cardiologists historically have ignored this area of intervention, relegating its management to vascular surgeons. In this article, we will savage the misconceptions regarding the endoluminal treatment of claudication and limb salvage as it relates to tibial-peroneal disease. Anatomy, imaging, access techniques, as well as the results of a decade’s experience with the technique will be explored, with the view of promoting a role for interventional cardiologists in the treatment of limb salvage.

Failed thrombolysis following ST-elevation myocardial infarction (STEMI) is associated with a poor prognosis. Rescue balloon angioplasty with or without stent implantation is an established treatment for failed thrombolysis. Recently, X-Sizer thrombectomy has been shown to be effective in removing intracoronary thrombi and improving coronary perfusion in patients with acute coronary syndrome. In this retrospective study, we sought to evaluate the safety and feasibility of X-Sizer-facilitated rescue percutaneous coronary intervention (PCI) for the treatment of STEMI after failed thrombolysis. Clinical data are from a retrospective review of 95 patients who underwent X-Sizer-facilitated primary PCI (n = 80) or rescue PCI (n = 15) during the period from November 2000 to February 2003. Baseline and procedural characteristics of the 2 groups were similar, except for a higher prevalence of hypercholesterolemia in the rescue PCI group. Angiographic success was achieved in 96% in the primary P

Pre-treatment of patients with clopidogrel prior to coronary angiography (CAG) and possible percutaneous coronary intervention (PCI) is a standard practice. Candidates for coronary artery bypass surgery (CABG) are discharged or remain in the hospital until CABG after clopidogrel is discontinued. We investigated whether any differences exist in the rates of surgical complications and outcomes between these two groups of patients. We conclude that continued hospitalization of clopidogrel pre-treated patients does not confer any safety benefit with regard to post-operative complications and 30-day mortality. Discharging these patients after CAG may reduce hospitalization costs.

Background. Ostial atherosclerotic lesions are distinct from other lesion sites in terms of outcomes following percutaneous interventions. Despite aggressive lesion modification strategies, long-term outcome is hampered by restenosis. Various stent designs have failed to show significant improvement in target lesion revascularization (TLR) rates. The present study evaluates the clinical outcomes following sirolimus-eluting stent implantation for ostial lesions. Materials and Methods. The sirolimus-eluting stent (SES) was the device of choice at our institute for all coronary interventions from April 2002 to March 2003. This study population is comprised of 50 patients who received drug-eluting stents for atherosclerotic ostial lesions during this period. Sixty-eight percent of the patients were male and 24 patients (48%) had a history of previous revascularization. Indication for intervention were as follows: acute myocardial infarction, 7 patients (14%), stable angina, 23 patients (

Objective. The goal of this study was to investigate the efficacy of stenting after rotational atherectomy (rotastent) for ostial LAD and ostial LCX stenosis in patients with diabetes. Background. Previous studies have demonstrated that rotastent for non-aorto ostial stenoses can be performed safely with high clinical success rate. However, in diabetic patients, long-term results of rotastent for ostial stenoses are still unknown. Methods. A series of 70 patients with de novo non-aorto ostial stenosis who underwent successful elective stenting after rotational atherectomy were the subject of this study. Clinical, angiographic, and procedural characteristics, as well as acute and chronic results were obtained for all patients. Results. There were no significant differences between diabetic versus non-diabetic patients in terms of baseline clinical characteristics, lesion characteristics, and procedural factors. The restenosis rate of diabetic patients was significantly higher than that

Background. Suture-mediated closure devices have been developed to improve patient comfort and safety following percutaneous coronary interventions (PCI). The Perclose AcceleRated Ambulation and DISchargE (PARADISE) trial which we reported previously showed that the Prostar® XL appears to be a safe and effective device to achieve hemostasis, improve time-to-ambulation and discharge post-PCI. The diameter of suture capture with the Closer™ 6 Fr suture-mediated closure device is larger than an 8 Fr hole. This study was performed to assess the pre-closure efficacy using the Closer device in terms of time-to-hemostasis, ambulation and discharge, as well as the incidence of peripheral vascular complications. Methods. Between January and September 2001, 153 consecutive patients were enrolled in this study. In 97 patients, the Closer sutures were introduced prior to insertion of the 8 Fr sheath (pre-closure arm). In 56 patients, the sutures were tied at the conclusion of PCI upon sheath remo

Patients with diabetes mellitus who undergo percutaneous coronary intervention (PCI) have higher rates of restenosis and a poorer prognosis than patients without diabetes. The American College of Cardiology/American Heart Association guidelines on exercise testing suggest that patients with diabetes may benefit from routine post-PCI functional testing (FT). To explore this issue, we examined the functional capacity, quality of life, event rates and procedural outcomes among 61 patients with diabetes enrolled in the Aggressive Diagnosis of Restenosis (ADORE) trial. All patients were randomized to either routine FT or selective FT and were followed for a period of 9 months. Patients with diabetes randomized to routine FT had a higher composite clinical event rate than those randomized to the selective FT strategy. Procedural rates did not differ significantly between the two groups. These results suggest that routine post-PCI FT in patients with diabetes is of little clinical value.