ABSTRACT: Suture injury of the left circumflex coronary artery and infarction may be an under-recognized complication of mitral valve annuloplasty. Our cases illustrate a potential role for early coronary angiography in patients who have persistent hemodynamic instability or ventricular irritability, which may be related to left circumflex artery injury. This potentially devastating complication of mitral annuloplasty can be diagnosed by use of intravascular ultrasound to distinguish suture injury from an atherosclerotic lesion.

ABSTRACT: Bilateral stenting of the common iliac arteries via the radial access route, in the same setting, is presented in this case report. Radial access limits bleeding complications, avoids the crossover technique and allows same-day discharge.

ABSTRACT: Off-pump coronary bypass surgery is an alternative to conventional bypass surgery and has the potential to reduce perioperative morbidity. Current techniques of snaring or inserting a shunt into the coronary artery to occlude flow and allow for anastomotic construction carry the risk of vessel trauma and subsequent graft failure. We present two cases in which PercuSurge GuardWires were used as an endovascular clamp in a hybrid operating room/catheterization laboratory to transiently occlude flow down the native left anterior descending artery during left internal mammary artery anastamotic construction.

ABSTRACT: Background. The degree of myocardial reperfusion after primary percutaneous coronary intervention (PCI) may be reduced by distal embolization. We tested the safety, feasibility and efficacy of a novel filter device, the Spider™ Distal Embolic Protection System, as an adjunct to primary PCI. Methods and Results. Twenty consecutive patients undergoing primary PCI with the Spider Embolic Protection Device were included in the analysis. Successful Spider device positioning was obtained in all cases, with predilatation of the lesions in 1 of these cases (5%). There were no procedural complications attributable to the use of a filter. Histological analysis of the content of 5 filters showed multiple embolic debris in all cases, from 8 to 48 particles per filter, from 101–1,299 mm in diameter and from 212–1,487 mm2 in area. The use of the Spider filter was associated with a profound ST-segment resolution (STR: 85.6 ± 16.5%) and the occurrence of complete (50%) STR of 90%. Con

ABSTRACT: Background. Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. Methods. Intermediate coronary artery stenoses (> 40% and < 70% diameter stenosis) were assessed by pressure wire. If the FFR was >/= 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. Results. Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 ± 0.71 mm, the QCA diameter stenosis was 52 ± 6% and the FFR was 0.89 ± 0.07. The ta

ABSTRACT: Objective. The purpose of this study was to evaluate the long-term outcomes of bifurcation coronary lesions treated with a novel technique called “balloon alignment T-stenting”. Background. The optimal technique for the treatment of bifurcation coronary disease has not yet been established. Methods. Twenty-six patients with bifurcation coronary lesions were treated with currently available drug-eluting stent (DES) platforms. This was a pilot study to determine the long-term efficacy of a novel technique, “balloon alignment T-stenting”. Based on this technique we performed 6-month anniversary angiography to determine restenosis rates for both main and side branch lesions treated. Results. Twenty-six main branches and 27 side branches were treated with this novel technique. Angiographic 6-month follow up was available for all 26 patients treated. There were no postprocedural mortalities and no cases of postprocedural stent thrombosis during the follow-up period. At 6-mon

ABSTRACT: The aim of this study was to compare clinical outcome of a stainless-steel stent coated with titanium nitride oxide (TITANOX) and a paclitaxel-eluting stent (PES) in routine clinical practice represented by two prospective registries including all patients with de novo coronary artery disease treated exclusively with a TITANOX stent (n = 201) or with a PES (n = 204) between May 2003 and November 2004 (63% of all PCI patients). The primary endpoint of the study was major adverse cardiac events (MACE) at 30 days and 12 months. The TITANOX stent patients were more frequently (p = 0.011) treated for acute myocardial infarction and had more complex B- and C-type lesions (p = 0.004). The PES patients had longer (p < 0.001) total stent length. At 30 days, the rate of MACE was 0% and 4.9% for the TITANOX stent and PES groups, respectively (p = 0.001). A significant difference in target vessel revascularization (TVR) was seen in favor of the TITANOX

ABSTRACT: Objectives. To evaluate the incidence of contrast-induced nephropathy (CIN) with the use of an automated contrast injection system in conjunction with contemporary measures to prevent CIN after cardiac catheterization and percutaneous coronary intervention (PCI). Background. The use of automated contrast injection systems can reduce the volume of procedural contrast, but whether lower contrast volume is associated with a lower incidence of CIN is uncertain. Methods. The incidence of CIN was assessed in 1,798 patients after diagnostic catheterization or PCI at Wake Forest University Baptist Medical Center from April 2002 to November 2004 using traditional handheld manifold injection systems, and in 377 subsequent patients using an automated contrast injection system. Preprocedural hydration was used on a routine basis, and N-acetylcysteine and bicarbonate infusion were used on an ad hoc basis. Outcomes were adjusted by standard logistic regression modeling. Results. Mea

ABSTRACT: Background. Direct stenting without balloon predilatation has been shown to be feasible and safe with drug-eluting stents, but no randomized comparisons between the two strategies exist. This study was designed to compare direct stenting with balloon predilatation followed by stent placement using only drug-eluting stents. Methods. One hundred and sixty-six consecutive coronary lesions in 95 consenting patients (mean age 59 ± 11 years; 12 women) were randomly assigned to direct stenting (n = 88), or balloon predilatation followed by stenting (n = 78), using sirolimus- or paclitaxel-eluting stents. Results. All procedures were uneventful. Crossover to balloon predilatation was necessary in 6 (7%) lesions randomized to direct stenting. During a 12-month follow up period, ischemia-driven angiography was performed in 13 patients. By intention to treat analysis, target lesion revascularization was required in 4 lesions, all of which were randomized to the predilatation grou

ABSTRACT: Objectives. To assess the safety and efficacy of the AngioJet® coronary device, given the uncertain risk-benefit balance of rheolytic thrombectomy in patients with acute myocardial infarction (AMI). Background. Current risk of inadequate myocardial perfusion for thrombus embolization in primary coronary interventions is not negligible. The AngioJet thrombectomy device showed promising results in terms of safety and efficacy, but failed to confirm them in a large, multicenter, randomized trial, and the risk-benefit balance is still uncertain. Methods. The AngioJet device was employed in 116 consecutive patients with AMI and angiographic evidence of extensive thrombosis in a vessel with a reference diameter > 2.5 mm. Stents and glycoprotein IIb/IIIa inhibitors were liberally used. Epicardial and myocardial reperfusion angiographic parameters, and in-hospital major adverse cardiac events (MACE, i.e., cardiac death, myocardial infarction, target vessel revascularization) w

ABSTRACT: Background. Adjunctive pharmacotherapy with eptifibatide, a glycoprotein (GP) IIb/IIIa inhibitor, as an intravenous bolus followed by infusion has been shown to improve outcomes in elective coronary interventions (PCI). However, bleeding complications and costs have limited the routine adoption of this regimen. Purpose. The goal of this study was to examine the safety, efficacy and cost-effectiveness of high-dose, single-bolus eptifibatide, without post-intervention infusion, in “real-world” patients undergoing elective PCI. Methods. We studied 401 patients with stable and unstable angina who were treated with a high-dose (20 mg), single bolus of eptifibatide plus heparin prior to the start of elective PCI. Exclusion criteria included recent MI, stenting of bypass graft(s), rotational atherectomy and/or brachytherapy. The primary study endpoints were major adverse clinical events (MACE), defined as the in-hospital and 30-day incidence of death from any cause, Q-wave or

ABSTRACT: Intracoronary radiation therapy (IRT), utilizing both gamma- and beta-emitting radiation sources, is considered to be a safe and effective treatment for in-stent restenosis (ISR). Although no longer in clinical use, a significant number of patients were treated in the past with IRT, and their long-term outcomes have not been well documented. The aim of the present analysis was to document the long-term outcomes of all patients who underwent IRT at our institution for the prevention of recurrence of ISR. Data were collected from 132 patients (148 irradiated lesions) treated with IRT at our institution between March 1999 and January 2004. Clinical and angiographic data were collected over a 5-year period. Patients were divided into 2 groups: those with failed IRT (n = 65), defined as a procedure that resulted in a major adverse cardiac event: death, myocardial infarction, target lesion revascularization, target vessel revascularization or coronary artery bypass gr

ABSTRACT: Guide catheter-induced dissection of the coronary arteries is an uncommon but potentially catastrophic complication of diagnostic and interventional cardiac catheterization. Several factors placing the individual at higher risk of this complication have been identified. We discuss these risk factors and utilize them to propose methods to prevent dissections. Management options of coronary artery dissection are also discussed.