Combined percutaneous coronary and peripheral intervention in patients with coronary and peripheral vascular disease can be time and cost saving. Despite the potential benefit, such hybrid procedures have been rarely reported. We report two cases of hybrid peripheral and coronary intervention that were performed at our institution with excellent outcomes. This is followed by a review of the literature.

Approximately 0.3–2% of patients may have anomalous origins of the coronary arteries. Anomalous origin of the left coronary artery (LCA) or left anterior descending (LAD) artery from the right sinus has been well described. In persons in whom the course involves an interarterial track between the aorta (Ao) and pulmonary artery (PA), an increased incidence of sudden death has been reported, particularly during or shortly after exercise. This has been felt to be due to transient occlusion of the anomalous LAD from increased blood flow through the Ao and PA as the anomalous LAD courses between them, possibly causing myocardial ischemia. In an elective setting, further anatomic delineation with other methodologies such as cardiac magnetic resonance (MR) imaging is recommended. In this case report we present an emergent percutaneous coronary intervention (PCI) of an anomalous LAD arising from the right sinus of Valsalva and coursing between the Ao and PA in a nonsurgical candidate.

Background. The majority of percutaneous artery interventional failures is due to the inability to deploy stents in patients with tortuous arteries, fibrotic lesions and/or calcified plaque. Recent reports of lubricant-facilitated stent delivery have described the use of either dipping the stent into solution or applying the solution to the stent surface prior to insertion into the guiding catheter. This report demonstrates that injection of undiluted RotaGlide into the guiding catheter can better facilitate stent delivery into patients. Following unsuccessful stent placement, 2 cc of undiluted RotaGlide was injected into the guiding catheter by syringe with the undeployed stents just proximal to the lesion site. The stents were advanced and deployed without difficulty at the lesion site. This is the first report of RotaGlide being injected into the guiding catheter, resulting in what may be decreased friction of the buddy wire and/or stent. RotaGlide-facilitated stenting may be the be

Myocardial bridging, systolic compression of an intramyocardial segment of an epicardial coronary artery, is well known to involve native coronary arteries. Systolic compression of bypass grafts has been rarely described. We present two cases of dynamic systolic compression of bypass grafts to native coronary arteries: one of a vein graft to the right coronary artery, and another of a left internal mammary artery to the left anterior descending artery.

See print version of the May 2006 issue for the CME test form or contact: North American Center for CME (NACCME) E-mail: tlevy@naccme.com Learning objectives. At the conclusion of this activity, the participant should be able to: 1) understand the basic criteria for the use of intracardiac echocardiography; 2) describe the steps in the performance of intracardiac echocardiography and its use in cardiovascular interventions; 3) define the different uses of the two types of intracardiac echocardiography systems; and 4) differentiate between the two systems. Activity instructions. Successful completion entails participants obtaining a score of at least 70% on the post-test. A certificate of completion will be mailed to the address listed on your post-test/evaluation form within 6 weeks of receipt of the documents. Estimated time to complete this activity: 1 hour Initial release date: May 1, 2006 Expiration date: May 1, 2007 Target audience: Ca

Background. Intracoronary thrombus is often problematic during percutaneous coronary intervention. Rinspiration™ is a new thrombectomy catheter system designed to mechanically disrupt and remove intravascular thrombus. Methods. “Rinspiration” thrombectomy was performed in 15 patients with angiographically visible thrombus in native coronary arteries (10 cases) and in saphenous grafts (5 cases). Indications included acute myocardial infarction in 11 patients and postinfarction ischemia in 4 patients. Results. The Rinspiration system appeared relatively simple to use. There were no device-related complications. Thrombectomy resulted in an improvement in thrombus grade from 3.8 ± 1.6 to 2.5 ± 1.7 (p = 0.02), and TIMI flow from 1.5 ± 1.3 to 2.2 ± 1.0 (p = 0.047). Stenting further improved thrombus grade to 0.8 ± 1.6 and TIMI flow to 2.6 ± 0.8. At 30-day follow up all patients remained free of repeat revascularization and reinfarction; 1 patient died from hemorrhagic stroke. Conclusions. Th

Background. This trial assesses the safety and efficacy of the PicoElite stent (amg International GmbH, Raesfeld-Erle, Germany), a new paclitaxel-eluting polymer-based stent. Methods. This is a first-in-man, single-center pilot trial that randomized 30 patients with 35 de novo coronary lesions in a 2:1 proportion to either the paclitaxel-eluting PicoElite stent (PES group: 20 patients with 24 lesions) or the bare metal ArthosPico stent (BMS group: 10 patients with 11 lesions). Results. Baseline characteristics were similar in both groups, apart from younger patients in the PES group (mean age 63.5 years vs. 71.7 years in the BMS group; p = 0.032) and shorter lesion length in the PES group (9.56 mm vs. 14.25 mm in the BMS group; p = 0.02). In both groups, there was no difference in the primary endpoint of major adverse cardiac events (MACE) at 30-day follow up. There was a nonsignificant trend towards lower 6-month MACE and target lesion

Objective. Some patients with acute coronary syndrome (ACS) have large myocardial infarction but others have small or no infarction. However, what makes this difference has not been clarified. We compared the angioscopic findings between those two categories of ACS patients and examined the association between the severity of ACS and the morphology of both culprit lesion and nonculprit coronary segments. Methods. Prospectively and consecutively enrolled patients with ACS were classified as CK-elevation-ACS (CKE-ACS; n = 54) or non-CK-elevation-ACS (NCKE-ACS; n = 22). Patients were diagnosed as CKE-ACS when the elevation (> twice normal upper limit) of CK-MB was detected; otherwise, patients were diagnosed as NCKE-ACS. They all underwent emergent catheterization and PCI of the culprit lesion. The entire culprit artery was observed by angioscopy, and the prevalence of thrombus and the color grade of yellow plaques were evaluated. The color grade of yellow plaq

Objectives. This study evaluated the clinical and angiographic effectiveness of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation for chronic total occlusion (CTO) lesions. Background. It has not been known which drug-eluting stent, SES vs. PES, is superior for the treatment of CTO lesions. Methods. This study comprises 107 CTO lesions which were successfully treated with SES implantation and 29 CTO lesions with PES implantation. Six-month angiographic restenosis rates and major adverse cardiac events (MACE) including death, nonfatal myocardial infarction and target lesion revascularization were compared between the two groups. Results. Baseline clinical characteristics were similar between the two groups. The procedural success rate was 98.1% in the SES group and 100% in the PES group. There was 1 sudden death due to in-hospital acute thrombosis in the PES group. There were no significant differences in baseline angiographic meas

Current classification systems of coronary bifurcation lesions are confusing and difficult to memorize. As coronary revascularization techniques become increasingly complex, it is important to establish a universal classification system. This manuscript proposes a simplified classification system that uses a combination of letters and numbers to provide a clinically relevant anatomic description of a given coronary artery bifurcation lesion. This classification consists of the prefix B (for Bifurcation lesion), followed by the addition of 4 separate suffixes. The first suffix consists of one of the letters C, N, S, or L. C = Close to the bifurcation: the lesion is close to a bifurcation, but the distance from the carina is more than the width of the plaque protruding into the lumen; N = Bifurcation lesion with one branch being Nonsignificant: nonsignificant being defined as less than 2.0 mm vessel diameter; S = Small proximal segment; or L = Large proximal segment: large defined as mor

Background. Intracoronary mononuclear cell therapy may produce angiogenesis in chronic myocardial ischemia. Potential complications include periprocedural infarction secondary to: reduced coronary blood flow; hyperviscosity from the cell preparation; or microvascular dysfunction. To date, no studies to evaluate these potential complications have been reported. The objective of this report was to study the safety and feasibility of intracoronary injections of autologous bone marrow mononuclear cells in a porcine chronic myocardial ischemia model. Methods. Domestic pigs (n = 5) underwent ameroid cuff placement of the left circumflex artery. Bone marrow-derived mononuclear cells (15 x 10^6 cells) labeled with CM dioctadecyl tetramethylindocarbocyanine were given by intracoronary injection. Animals were sacrificed, and hearts and vital organs were inspected grossly and by histopathology, and bone marrow underwent immunofluorescence microscopy. Results. Troponin I lev

The pressure-derived fractional flow reserve (FFR) is a valuable and well validated index for assessing the ischemic significance of coronary lesions. The 0.75 cutoff value of FFR discriminates between lesions with and without ischemic potential, helps decision making as to whether to revascularize a coronary stenosis and assists in evaluating the results of catheter-based treatment. Recent data show that the FFR index is also useful in managing patients with complex coronary disease. The aim of this paper is to provide an overview of the theoretical background of this index and its clinical applicability in the catheterization laboratory.