Background. The ability to estimate the rate of a new target vessel revascularization (TVR) after bare metal coronary stenting is an important issue, as the systematic use of drug-eluting stents is still limited by its high costs. Objective. We sought to create a predictive score for the possibility of a new TVR after bare metal stenting. Methods. Clinical and angiographic characteristics of a prospective cohort of 848 patients were included in a dedicated database. Independent predictors of 1-year TVR were identified by multivariate analysis, and the score points were assigned according to the relative risk ratio of 1-year TVR. Results. The 1-year TVR rate in the 848 patients was 7.4%. By multivariate analysis, reference diameter, lesion length and diabetes mellitus were retained in the final model (Hosmer-Lemeshow goodness-of-fit test = 2.339; p = 0.969). The increase of 1-year TVR rates was almost linear, with each score level (0 = 1.4%, 1 = 4.5%, 2 = 7.1%, 3 = 10.4% and 4/5 = 15.7%

Primary angioplasty has become the preferred therapeutic modality in patients with acute myocardial infarction (AMI). Despite restoration of antegrade epicardial flow by mechanical reperfusion therapy, angiographically assessed microvascular function and myocardial reperfusion (blush) allows for the stratification of patients with epicardial TIMI 3 flow into different strata of survival. Despite this fact, the best approach to achieving good myocardial blush has not yet been established. We sought to determine the efficacy of 3 different vasodilators. Methods. A cohort of 40 patients were referred for primary angioplasty in the setting of STEMI; their TIMI 3 flow was achieved and myocardial blush (MB) was 0–1 (no myocardial opacification) according to the vant’Hof classification. The patients were assigned to 1 of 3 investigational groups: intracoronary (IC) injection of nitroprusside, adenosine and verapamil, and were compared with the control group: IC injection of nitroglycerin, the

A 6-month-old child with worsening cyanosis from birth, hypercyanotic spells and failure to thrive, was admitted with severe desaturation. Systemic saturation was < 56%, and echocardiography revealed severe infundibular pulmonary stenosis with normal pulmonary valve and a restrictive ventricular septal defect. The child underwent percutaneous stenting of the right ventricular outflow tract (RVOT), with good reduction in gradient and clinical stabilization. The child is being followed up for elective intracardiac repair.

Numerous methods have been described for retrieving or addressing stents that have embolized in the coronary arteries. Almost all of these prior reports address the “freshly” embolized stent with retrieval or deployment occurring during the same index procedure during which the embolization occurred. We describe a case of a thrombosed, chronically embolized coronary stent.

We describe our experience performing cardiac catheterization of the left coronary artery in a patient with an aneurysm of the ascending aorta using a double-catheter technique. A 7 Fr guiding catheter was advanced into the aortic root and a longer multipurpose diagnostic catheter was passed through the guiding catheter, which enabled the extension of the whole catheter system. In addition, this technique allowed us to reach the ostium of the left coronary artery and perform coronary angiography.

Automobile airbags have been universally installed to save lives in motor vehicle accidents, but have also been linked with facial and thoracic burns and chest trauma during rapid deployment. Blunt trauma to the chest may result in electrical and mechanical injuries to the heart and great vessels. We report a case of a 19-year-old man who presented with acute myocardial infarction following a blunt chest trauma from an automobile airbag deployment. Although mechanical complications resulting from airbag injury have been reported in the past, this is the first report of an acute thrombotic coronary occlusion triggered by the rapid airbag deployment. The case underscores the importance of systematic clinical evaluation to guide management in patients with confounding clinical presentation.

Atypical right-to-left shunts following Fontan surgery were closed by transcatheter techniques using various devices in 4 patients. Three had variants of hypoplastic left heart syndrome, while the other had tricuspid atresia. Large Fontan baffle leaks were present in 2, a residual fistula from the inferior vena cava to the coronary sinus was present in 1, and another patient had surgical tube fenestration of an extracardiac conduit. When careful catheter and transesophageal echocardiographic exploration is performed, the selection of appropriate devices makes closure of these defects feasible.

An acute inflammatory response occurs following percutaneous coronary and peripheral vascular interventions (PVI), partly mediated by platelet activation. Glycoprotein (GP) IIb/IIIa inhibitors might partially attenuate this inflammation rise in the coronary patient, but data in patients undergoing PVI are lacking. In the Integrilin Reduces Inflammation in Peripheral Vascular Interventions trial (INFLAME), we hypothesized that eptifibatide reduces the acute inflammatory responses following PVI. This is a single-center, randomized, open-label study of intravenous eptifibatide (180 µ/kg bolus x 2, 10 minutes apart, then 2 µ/kg/min infusion over 18 hours) and low-dose unfractionated heparin (60 Units per kg, target activated clotting time (ACT) 200–250 sec) [LDH+I group; n = 21] versus high-dose unfractionated heparin alone (100 Units per kg, target ACT 300–400 sec) [HDH group; n = 21] in patients undergoing iliac and infrainguinal interventions. The primary endpoints of the study were ma

Background. Among patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention (PCI), those with multivessel disease have worse clinical outcomes. This study sought to elucidate the impact of a chronic occlusion in a noninfarct vessel among patients with multivessel disease undergoing PCI for AMI. Methods and Results. We studied 630 patients with AMI treated with PCI within 12 hours of symptom onset. Three groups of patients were defined: Group 1 (single-vessel disease; n = 345); Group 2 (multivessel disease with no chronic coronary occlusion in another vessel; n = 201); and Group 3 (chronic coronary occlusion in another vessel; n = 84). The probability of being free from events was lower in patients with multivessel disease than in Group 1 (84 ± 2% vs. 92 ± 1% at 30 days; 71 ± 3% vs. 81 ± 3% at 2 years; Log-Rank: p = 0.001; Breslow: p < 0.001 ), and in Group 3 than in Group 2 (76 ± 5% vs. 87 ± 2% at 30 days; 63 ± 6% vs.75 ± 4% at 2 years; Log

Positive coronary artery remodeling is associated with unstable coronary syndromes. Serum inflammatory markers, including high-sensitivity CRP (hsCRP), can predict future risk of acute coronary events in patients with stable coronary artery disease. We sought to elucidate the relationship of specific serum inflammatory markers with intravascular ultrasound (IVUS) estimation of coronary artery remodeling in patients with stable coronary artery disease. Thirty-one sequential patients at our institution undergoing IVUS-assisted percutaneous coronary intervention (PCI) with stable coronary artery disease were enrolled. Automated IVUS pullback and offline analysis were performed in all patients. Images were analyzed for vessel wall area (VWA) and lumen area (LA), at the culprit lesion and at a proximal reference site, and the remodeling index (RI) was calculated. Positive and negative remodeling were defined as a RI of > 1.05 and < 0.95, respectively. ELISA essays were performed for solubl

Objectives. To describe a novel approach to drug-eluting stent (DES) implantation, the “sandwich” technique, comprised of the simultaneous implantation of two completely overlapping DES in the same target lesion. Background. DES effectively prevent restenosis in selected coronary lesions. However, adverse lesion characteristics may detrimentally affect outcomes after DES implantation by means of plaque prolapse, recoil or excessive neointimal hyperplasia. Methods. From July 2002 to November 2004, the sandwich technique was performed in 10 patients with very high-risk lesions. Two DES of identical size and length were implanted, one inside the other, with almost complete overlap. High-pressure post-dilatation (up to 28 atm) was carried out in 6 cases. The endpoints of this preliminary evaluation were: technical feasibility, early (30-day) safety, restenosis rate and freedom from adverse events at 9-month follow up. Results. Procedural and angiographic success was achieved in all cases.