Acute stent thrombosis is a rare but serious complication of stent implantation. Although anecdotal reports suggest that the use of drug-eluting stents (DES) may increase the risk of stent thrombosis, this has not been borne out in randomized, controlled trials. We report a case of acute stent thrombosis following implantation of a DES, with review of the literature. Despite the initial favorable procedural result, the patient developed stent thrombosis 7 days later; intravascular ultrasound (IVUS) demonstrated incomplete deployment of the stent. We recommend the use of IVUS in the management of acute stent thrombosis in order to exclude incomplete stent expansion which may underlie acute thrombotic occlusion.

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has a lower success rate than nontotal occlusions. Like nontotal coronary occlusions, successful procedural outcomes of CTOs confers improvement in clinical outcomes. Reasons for unsuccessful PCI of CTOs may stem from various steps of the procedure including failure to cross the occlusion with a guidewire or a balloon, or failure to adequately dilate or modify the lesion. The Frontrunner™ blunt microdissection device is designed to improve the odds of guidewire passage through coronary occlusions, whereas the Rotablator® rotational atherectomy device is intended for plaque modification, especially in resistant, elastic or calcific lesions. The Frontrunner and Rotablator can each facilitate the procedure at their respective junctures; the combined use of these technologies can enhance the overall PCI success rates, especially regarding difficult CTOs. This case presentation encounters two technical challenges: t

Central venous catheterization has become an important technique for the diagnosis and management of patients requiring intensive medical care.1–3 The use of devices to perform this procedure has been accompanied by a corresponding increase in complications.3,4 The embolization of foreign bodies to the venous system is not a rare event. This is a report on the transluminal effective and relatively easy removal of a sheath fragment from the right ventricle using standard angioplasty tools.

ABSTRACT: Background. Prior studies of atheroablation (directional atherectomy, rotational atherectomy and laser angioplasty) have demonstrated either no advantage or worse outcomes relative to conventional balloon angioplasty. Because these techniques are still required in a minority of patients, we hypothesized that the use of drug-eluting stents (DES) would minimize the rate of major adverse cardiac events (MACE) after atheroablation. Methods. From 2,252 percutaneous coronary intervention procedures, 212 patients were extracted using case control matching and were analyzed to compare the rate of MACE across four groups (DES with atheroablation, bare-metal stent (BMS) with atheroablation, DES without atheroablation, bare-metal stent without atheroablation). A Cox proportional hazards model was constructed to determine predictors of MACE after adjustment for potential confounders. Internal validation was performed with bootstrapping. Results. There were 36 patients, 42 patients, 63 pa

ABSTRACT: Objective. We examined outcomes of clinical restenosis and temporal trends in repeat target vessel revascularization (TVR) among a broad, unselected patient population undergoing percutaneous coronary revascularization. Background. The extent to which clinical trials involving protocol-specified follow-up angiography reflect real-world practice where interventions are driven by clinical restenosis is not completely understood. Whether clinical outcomes have varied over a long-term period that has paralleled substantial advances in stent design, balloon delivery catheter and adjunctive pharmacologic therapies is uncertain. Methods. To characterize the effectiveness of coronary stenting in routine practice, we examined 1-year clinical outcomes of death and repeat TVR among 5,765 patients enrolled in the Duke Database for Cardiovascular Disease who underwent stent placement between 1994 and 2002. To assess for temporal trends in outcomes, patients were further divided into terti

ABSTRACT: Background and Objective. End-stage renal disease (ESRD) patients on chronic dialysis are at heightened risk for target vessel revascularization (TVR) after coronary stenting. However, ESRD patients were excluded from the trials that demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) in reducing TVR. We sought to identify the impact of stent type (DES versus BMS) on TVR and other cardiac adverse events in ESRD patients. Methods. The study included 89 consecutive ESRD patients who underwent coronary stenting and were followed for ? 9 months. TVR was the primary endpoint, and the secondary endpoint was a composite of death, myocardial infarction (MI) and TVR. Multivariate logistic regression models were used to adjust for differences in clinical and procedural characteristics. Results. DES were used in 24 and BMS in 65 patients. The stent diameter was smaller (p = 0.008), but the stent length was longer (p = 0.006) in the DES group. TVR was r

ABSTRACT: Objective. To study the suitability of the aberrant radial artery (ARA) as an access site for coronary angiography and angioplasty. Background. In certain situations, the radial artery operator finds that the right radial artery in its usual location is unsuitable for a transradial procedure (TRP). In such cases, the ARA should be considered as an alternate access site. Methods. Between January 2002 and December 2004, all patients considered suitable for a TRP with a clinically absent radial artery, or a small radial artery and a palpable ARA, underwent a TRP using this vessel as an access site. We describe the technical aspects and the differences that this approach entails, in comparison to the standard radial artery approach to TRPs. Results. Of the 3,610 patients considered suitable for a TRP, 22 patients underwent 29 procedures using the ARA as an access site [22 angiograms and 7 percutaneous transluminal coronary angioplasty procedures (PTCAs)]. The median age of the pa

ABSTRACT: Objective. Stent thrombosis and in-stent restenosis remain problematic despite drug-eluting stents (DES), especially in diabetic patients and in those with small-vessel disease. Eptifibatide inhibits the platelet glycoprotein IIb/IIIa and smooth muscle cell (SMC) avb3 receptor, thus potentially influencing both thrombosis and proliferation. The aim of the present studies was to examine the absorption and elution characteristics of eptifibatide on polymer-coated stents and investigated their effect on SMC proliferation, platelet deposition and platelet aggregation in vitro. Methods and Results. Polymer-mixed eptifibatide and H3-labeled eptifibatide were loaded onto bare metal stents. A maximum of 111 µg of eptifibatide was loaded onto 3.0 x 18 mm stents. Drug elution characteristics were tested in a PBS perfusion circuit. Elution profile consisted of an early rapid phase (24% ± 0.03 loss over 1 hour) followed by a sustained release with 44% ± 2.30 still present on the stent af

ABSTRACT: Aims. Restenosis has been the principal limitation of bare metal stents. Based upon the presumption that platelet and inflammatory cell recruitment initiate neointimal proliferation, we explored a novel polymer coating that reduces cell-stent interactions. The purpose of the present study was to investigate the effect of poly(L-lysine)-graft-poly(ethyleneglycol) (PLL-g-PEG) adsorbed to stent surfaces to reduce neointimal hyperplasia in the porcine restenosis model. Methods and Results. Seven animals were instrumented each with 2 stainless steel stents (15 mm length, 2.5–3.5 mm diameter), randomly implanted in 1 major epicardial coronary artery. One stent was dip-coated with PLL-g-PEG, whereas the other stent served as the uncoated control stent. All animals were sacrificed after 6 weeks for histological examination. Neointimal hyperplasia was significantly less (-51%) in the PLL-g-PEG-coated stents (1.15 ± 0.59 mm2) than in the uncoated control stents (2.33 ± 1.01 mm2; p < 0.

ABSTRACT: Background. In the drug-eluting stent era, minimum stent diameter is one independent predictor of restenosis. Some plaque modification is necessary before stenting to obtain the minimum stent diameter, but plaque modification using current devices is difficult in certain lesions, such as those in eccentric small vessels. As a potential solution to this problem, we investigate the usefulness of a single-blade Cutting Balloon (SCB) in this study. Methods. We used the SCB in 5 porcine coronary arteries (2 LAD, 1 LCx and 2 RCA) to investigate the feasibility of directional atherotomy. We also tried the kissing balloon technique (KBT) with the SCB in 3 bifurcations from the same arteries. We used intravascular ultrasound (IVUS) guidance to position and direct the atherotome using the side holes of the guiding catheter as a marker. We also assessed plaque modification with IVUS before and after percutaneous coronary intervention and took coronary sections to inspect tissue patholog