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The Journal of Invasive Cardiology - ISSN: 1042-3931 - Volume 18 April - Issue 4 - April 2006 | |
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| Rajesh Vijayvergiya, DM, Ajay Jagannath Swamy, MD, Anil Grover, DM |
The buddy wire technique, i.e., using an additional 0.014 inch coronary guidewire along with the one being used to advance balloons, stents or other devices help to accomplish otherwise challenging procedures during percutaneous coronary intervention (PCI). It improves the balloon or stent support and also provides the guiding catheter stability. It is a simple, quick, easily available and deliverable method for complex lesions during PCI. We report technical aspects of a case of a mid-left anterior descending (LAD) calcified lesion in which a buddy wire facilitated the procedural success of PCI.
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Filters to Prevent Distal Embolization during Coronary Artery Stenting: The Risk of Mousetrap |
| Ugo Limbruno, MD, Alberto Genovesi Ebert, MD, Michele Galli, MD
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We describe a case of acute coronary syndrome treated with percutaneous intervention using a distal protection system that was complicated by filter entrapment into the stent struts. We discuss the advantages and concerns of distal protection and suggest some technical aspects to take into account when dealing with filter protection systems.
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Abciximab in ST-Elevation Acute Myocardial Infarction Occurring in a Heart Transplant Recipient and Treated with Stenting |
| Leonardo Varotto, MD, Luigi La Vecchia, MD, Alessandro Fontanelli, MD |
The authors describe primary coronary intervention consisting of direct stenting after abciximab administration in a case of acute anterior myocardial infarction occurring in a heart transplant recipient with triple-vessel disease. Primary success was obtained and the patient survived to a one-year angiographic follow up which showed persistent coronary patency. This is the first report concerning the use of abciximab in primary stenting for acute myocardial infarction in allograft coronary artery disease.
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Early Aneurysm Formation after Drug-Eluting Stent Implantation: An Unusual Life-Threatening Complication |
| Ripen K. Gupta, MD, Rakesh Sapra, MD, Upendra Kaul, MD |
Coronary aneurysm after stent implantation is a rare complication. Coronary aneurysms have been reported after drug-eluting stent implantation, but there has been no clear elucidation of time course, mechanism and therapeutic implications. We report two patients who developed coronary aneurysms within two weeks of the procedure and required surgical intervention to treat the complication. The possible putative mechanisms are discussed.
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| Mostafa Dastani, MD, Vahid Jorat, MD, Bernhard Meier, MD
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| Michael S. Lauer MD and Stephen Ellis, MD |
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| Edward J. Yoon, MD, Ernest Haeusslein, MD, Bruce Brent, MD
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There has been limited published experience with the use of sirolimus drug-eluting stents in the setting of cardiac transplant vasculopathy. Systemic sirolimus has been shown to protect against progressive transplant vasculopathy, and sirolimus-eluting stents have shown to reduce the risk of in-stent restenosis in native coronary arteries. We report a case of acute myocardial infarction in the setting of advanced transplant vasculopathy, and describe the long-term results of sirolimus drug-eluting stent implantation.
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| Vinicius D. Vaz, MD, Alexandre Abizaid, MD, PhD, Aurea Chaves, MD, PhD, Fausto Feres, MD, PhD, Eduardo Ferreira, MD, Luiz Mattos, MD, PhD, Rodolfo Staico, MD, Andrea Abizaid, MD, PhD, Luiz Tanajura, MD, PhD, Marinella Centemero, MD, PhD, *Gary Mintz, MD, Amanda Sousa, MD, PhD, J. Eduardo Sousa, MD, PhD |
Background. Sirolimus-eluting stents (SES) have already demonstrated their long-term effectiveness in suppressing neointimal hyperplasia in non-high risk patients. The long-term follow up of diabetic patients treated with SES has not been yet evaluated. Methods and Results. Quantitative coronary angiography and intravascular ultrasound analysis were performed in 35 diabetic patients treated with a SES at short- (6.0 ± 1.0 months) and long-term (18.5 ± 4.9 months) follow up. There were no significant changes in the in-stent minimum lumen diameter (MLD) between short- and long-term follow up (2.69 ± 0.46 vs. 2.61 ± 0.44 mm; p = 0.5), as well as in the in-lesion MLD (2.38 ± 0.54 vs. 2.30 ± 0.62 mm; p = 0.6). None of the patients reached binary restenosis (diameter stenosis > 50%) at either follow-up periods. Stent obstruction volume by 3-D IVUS was very small at short-term follow up and has remained virtually the same at long-term follow up (3.4% vs. 3.5%; p = 0.8). There were no aneurysm
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Lack of Benefit for Routine Functional Testing Early after Coronary Artery Bypass Graft Surgery: Results from the ROSETTA-CABG Registry |
| Mark J. Eisenberg, MD, MPH, Karen Wou, Hiep Nguyen, MD, Robert Duerr, MD,
Michael Del Core, MD, Dominique Fourchy, MD, Thao Huynh, MD, Ellis Lader, MD,
Felix J. Rogers, DO, Rashid Chaudhry, MD, Karen Okrainec, MSc, Louise Pilote, MD, MPH, PhD |
Background. There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy. Objective. To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events. Methods. The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG. Results. Patients were predominantly male (80%) with a mean age of 63 ± 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284
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Nitroglycerin, Nitroprusside, or Both, in Preventing Radial Artery Spasm during Transradial Artery Catheterization |
| John Coppola, MD, *Tejas Patel, MD, Tak Kwan, MD, Kintur Sanghvi, MD, Sudhesh Srivastava, MD, *Sanjay Shah, MD, Cezar Staniloae, MD |
Objective. Radial artery spasm remains a major complication of transradial coronary interventions. The aim of this study was to compare the efficacy of three different intra-arterial vasodilating cocktails in reducing the incidence of radial artery spasm in patients undergoing transradial coronary angiography. The secondary goal was to assess the predictors of arterial spasm in this large group of patients. Methods. A total of 379 patients undergoing the procedure were randomly enrolled in 1 of 3 groups. Every patient in each of the 3 groups received intra-arterial heparin, lidocaine and diltiazem. Along with that, patients in Group A received nitroglycerin; patients in Group B received nitroprusside instead of nitroglycerin; and patients in Group C received both nitroglycerin and nitroprusside. A single experienced operator, blinded to the study drug, subjectively determined the presence of spasm. Results. Of 379 patients, a total of 44 patients (11.6%) experience
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Combination Therapy with Aspirin, Clopidogrel and Warfarin Following Coronary Stenting is Associated with a Significant Risk of Bleeding
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| Zakaria Khurram1, MD, Eric Chou2, MD, Robert Minutello3, MD, Geoffrey Bergman3, MD, Manish Parikh3, MD, Srihari Naidu3, MD, S. Chiu Wong3, MD, Mun K. Hong3, MD |
Dual antiplatelet therapy of aspirin and a thienopyridine is the standard of care following coronary stenting. Patients who are on chronic warfarin therapy and receive a coronary stent need to be treated with the triple therapy of aspirin, clopidogrel and warfarin; however, the bleeding risk in these patients is unknown. To evaluate the bleeding risk in patients requiring chronic warfarin therapy and undergoing stent implantation, we compared 107 consecutive patients on chronic warfarin therapy who underwent coronary stenting and were discharged on aspirin, clopidogrel and warfarin to 107 contemporary patients who were treated with aspirin and clopidogrel. We evaluated their bleeding history before and after coronary stenting. Major bleeding was defined as bleeding that was significantly disabling, intraocular or requiring at least 2 units of blood transfusion. Minor bleeding was defined as other bleeding that led to interruption of the medications. Patients on triple therapy were youn
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Morphology and Location of Restenosis Following Bare Metal Coronary Stenting |
| Marc J. Schweiger, MD, Ehsan Ansari, MD, Gregory R. Giugliano, MD, *James Mathew, MD, Ashequl Islam, MD, John Morrison, MD, James R. Cook, MD |
Restenosis following bare metal coronary stenting is common. The location and characteristics of restenotic lesions in patients who have undergone coronary stent implantation is not well described. The purpose of this study was to determine the location, type and temporal distribution of stent-related restenosis. We reviewed the clinical and angiographic characteristics of 203 consecutive patients with stent-related restenosis undergoing a repeat clinically-indicated coronary angiogram, 30 days to 1 year after the index procedure. All lesions within 10 mm of the proximal and distal margins of the stent were included in the analysis. An angiographic classification was developed based on lesion location. Class I lesions were those occurring within the stent, and Class II comprised those lesions occurring within 10 mm of the proximal and distal stent edge. We classified a total of 234 stent-related restenosis lesions. Class I lesions were found in 52% of patients, and Class II in 48%. Th
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A Multicenter, Randomized, Dose-Finding Study of Gamma Intracoronary Radiation Therapy to Inhibit Recurrent Restenosis after Stenting |
| aMatthew J. Price, MD, bJeffrey W. Moses, MD, bMartin B. Leon, MD, bRoxana Mehran, MD, bManuela Negoita, MD, bAlexandra Lansky, MD, bMichael Collins, MD, aHuan Giap, MD, aRay Lin, MD, aShirish Jani, PhD, aStephen Steuterman, MS, bStephen Balter, PhD, cJack Dalton, MD, cRoberto Lipsztein, MD, aPrabhakar Tripuraneni, MD, aPaul S. Teirstein, MD |
Objectives. The objective of this double-blind, randomized study was to determine the safety and efficacy of intracoronary radiation therapy (ICRT) with a dose of 17 Gray (Gy) compared to the currently recommended dose prescription of 14 Gy for the treatment of in-stent restenosis within bare metal stents. Background. While gamma ICRT for in-stent restenosis has been proven efficacious, the optimal dose is unknown, and radiation failure due to recurrent neointimal hyperplasia remains a significant clinical problem for some patients. A higher radiation dose may improve outcomes, but may potentially increase adverse events. Methods. Following coronary intervention, 336 patients with in-stent restenosis were randomly assigned to receive ICRT with either 14 Gy or 17 Gy at 2 mm from an 192-iridium source. Results. At 8-month follow up, fewer patients in the 17 Gy group underwent target lesion revascularization (TLR = 15.2% versus 27.2%; p = 0.01), target vessel r
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| John Macdonald, MD, Manivannan Srinivasan, MD, Ranjit More, MD |
The optimal management strategy for patients with von Willebrand’s disease presenting with acute coronary syndromes is unclear. We present a clinical case of percutaneous coronary intervention following an acute coronary syndrome in a man with von Willebrand’s disease. Other published case reports are reviewed. The central role of von Willebrand factor in the pathophysiology of acute coronary syndrome and the possible cardioprotective effects of low levels of the protein are discussed. Practical considerations regarding hemostasis and antiplatelet therapy are addressed. Finally, recommendations for the management of patients with von Willebrand’s disease presenting with acute coronary syndromes are suggested.
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 Create a Successful Vena Cava Filter Practice
Accredited CD
This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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Release Date: December 8, 2006