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The Journal of Invasive Cardiology - ISSN: 1042-3931 - Volume 19 - Issue 4 - April 2007 | |
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| Spyros Kokolis, MD, Alan Feit, MD, Jonathan D. Marmur, MD
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| Jack P. Chen, MD, FACC, FSCAI, FCCP |
ABSTRACT: Methamphetamine (MET) is a growing public health concern and is prevalent in, although not limited to, the youth. The drug’s association with myocardial infarction is well described and is attributed to accelerated atherosclerosis, hypercoagulable state, and macrovascular epicardial coronary spasm. However, global slow-flow of all coronary systems in the absence of significant stenoses has not been previously reported. We hereby present a young patient who likely experienced severe, global microvascular coronary spasm unrelieved by intracoronary vasodilator therapy, resulting in acute myocardial infarction. The pharmacology of MET, its postulated mechanism in acute coronary syndromes, as well as the pathophysiology and treatments of microvascular coronary spasm are briefly reviewed. Readers are recommended to be vigilant of potential illicit drug use in patients with atypical presentations of acute coronary syndromes.
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| Guilherme Bromberg-Marin, MD, Ehtisham Mahmud, MD, Sotirios Tsimikas, MD |
ABSTRACT: We report a case of spontaneous multivessel coronary vasospasm leading to anterior myocardial infarction and cardiogenic shock in the setting of treatment with methylphenidate and withdrawal from beta-blockers and calcium channel-antagonists. The patient was stabilized with an intra-aortic balloon pump and treated with coronary stenting and vasodilators and ultimately had an uneventful recovery. We review the diagnosis and treatment of coronary vasospasm and the implications of coronary vasoreactivity in the pathophysiology of myocardial infarction.
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Late Stent Thrombosis Associated with Coronary Aneurysm Formation after Sirolimus-Eluting Stent Implantation |
| *Shahid Aziz, BSc, MD, MRCP, John L. Morris, MD, FRCP, Raphael A. Perry, MD, FRCP |
ABSTRACT: Stent thrombosis is a rare but potentially fatal complication of coronary stent implantation. Its occurrence late after drug-eluting stent (DES) deployment has led to concerns regarding their long-term safety. We report a case of late stent thrombosis 26 months after sirolimus-eluting stent (SES) (Cypher™, Cordis Corp., Miami, Florida) implantation. This was associated with marked positive vessel remodeling and coronary aneurysm formation involving the stented segment of the coronary artery. The patient was on dual antiplatelet therapy at the time.
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Extreme Coronary Guide Catheter Support: A Case of a Novel Telescopic Guide Catheter System with a Contralateral Aortic Wall Support |
| *Adam T. Stys, MD, William Lawson, MD, David Brown, MD |
ABSTRACT: Extra support of the guide catheter is necessary in some cases of percutaneous coronary intervention (PCI). We describe a successful case of PCI of a very calcified and tortuous right coronary artery in which a modification of a novel telescopic guide system was applied. A long sheath that “armored” the guide catheter allowed extreme support derived from the contralateral aortic wall. The operator can adjust the support of the guide system from soft to extremely stiff.
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| Stéphane Cook, MD, Bernhard Meier, MD, Stephan Windecker, MD |
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| Richard E. Shaw, PhD, FACC, FACA
Editor-in-Chief |
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| Professor Nicholas G. Kounis, MD, PhD, FESC, FACC, George N. Kounis, MD, MSc, *George D. Soufras, MD, PhD |
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| Shinichi Furuichi, MD, Giuseppe M. Sangiorgi, MD, Altin Palloshi, MD, Cosmo Godino, MD, Flavio Airoldi, MD, Matteo Montorfano, MD, Alaide Chieffo, MD, Iassen Michev, MD, Mauro Carlino, MD, Antonio Colombo, MD |
Background. There is no specific study evaluating the outcome of DES implantation in trifurcation lesions. Objective. To evaluate the mid-term clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions. Methods. All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up. Results. A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior latera
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Propensity Score Analysis of Vascular Complications after
Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Using Thrombin Hemostatic Patch-Facilitated Manual Compression |
| Robert J. Applegate, MD, Matthew T. Sacrinty, MPH, Michael A. Kutcher, MD, Talal T. Baki, MD, Sanjay K. Gandhi, MD, Renato M. Santos, MD, Frederic R. Kahl, MD, William C. Little, MD |
ABSTRACT: Objectives. To evaluate the adjusted risk of vascular complications after thrombin hemostasis patch-facilitated manual compression (THP-MC) for femoral artery access site management. Background. Thrombin hemostatic patches shorten time to hemostasis after cardiac procedures involving femoral artery access, but whether these patches are as safe as manual compression remains uncertain. Methods. THP-MC (D-Stat Dry, Vascular Solutions, Minneapolis, Minnesota) was used in 3,464 consecutive patients including 2,464 diagnostic cardiac catheterizations (CATH) and 1,000 percutaneous coronary intervention procedures (PCI) performed via a femoral access at a single site (WFUBMC). A total of 4,371 procedures including 2,956 CATH and 1,415 PCI performed prior to use of THP-MC, and treated with manual compression, served as the control group. Ambulation was permitted 2–3 hours after THP-MC, and 3–8 hours after MC. Propensity to receive a THP was calculated, and
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Comparison of Vessel Response following Sirolimus-Eluting Stent Implantation as Assessed by Serial 3-D Intravascular Ultrasound Study |
| Katsuhisa Waseda, MD, PhD, Junya Ako, MD, Yoshihisa Shimada, MD, Yoshihiro Morino, MD, Ichizo Tsujino, MD, PhD, Yoichiro Hongo, MD, Krishnankutty Sudhir, MD, PhD, Paul G. Yock, MD, Peter J. Fitzgerald, MD, PhD, Yasuhiro Honda, MD |
ABSTRACT: Recent sirolimus-eluting stent (SES) studies have suggested higher rates of restenosis in non-left anterior descending (LAD) artery lesions. The aim of this study was to evaluate differential vessel response (LAD versus non-LAD) to SES implantation using serial intravascular ultrasound (IVUS). A total of 94 patients who underwent SES implantation and serial (post-PCI and 8 months) 3-dimensional IVUS were enrolled from our database. Volumetric analysis was performed throughout the stent as well as the adjacent reference segment (up to 5 mm). Volume index (volume/length) was calculated for vessel (VVI), lumen (LVI), and plaque (PVI). Cross-sectional narrowing (CSN) was defined as neointimal area divided by stent area (%). With respect to the in-stent segment, VVI, PVI, and LVI at post-PCI were not significantly different between the LAD (n = 41) and non-LAD (n = 53) lesions. At follow up, however, maximum CSN was significantly greater in the non-LAD lesions (18.3 ± 15.2%
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Sirolimus-Eluting Stents for the Treatment of Bare-Metal In-Stent Restenosis: Long-Term Clinical Follow Up
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| Imad Sheiban, MD, Amedeo Chiribiri, MD, Serena Beninati, MD, Claudio Moretti, MD, Pierluigi Omedè, MD, Filippo Sciuto, MD, Walter Grosso Marra, MD, Giuseppe Biondi-Zoccai, MD, Mario Bollati, MD, Alfonso Gambino, MD, Gian Paolo Trevi, MD |
ABSTRACT: Background. Studies focusing on short- and mid-term follow up support the beneficial role of sirolimus-eluting stents (SES) in the treatment of in-stent restenosis (ISR), yet no long-term safety and/or efficacy data are available. Methods. Patients with ISR following bare-metal stenting (BMS) and treated with SES were prospectively studied. Baseline, procedural, and in-hospital data were appraised. The primary endpoint was the rate of major cardiovascular events (MACE) at long-term follow up (>9 months). Secondary endpoints were the individual contributors to MACE. Results. A total of 180 SES were implanted to treat 138 consecutive patients. Procedural success was achieved in all patients without in-hospital death, acute stent thrombosis, stroke, or urgent coronary artery bypass. During follow up, MACE occurred in 5.8% of patients at 6 months, 14.3% at 12 months, and 25% at 24 months. Specifically, all-cause mortality was 1.7% at 6 months, 3.5% at 12 mont
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Sirolimus-Eluting, Bioabsorbable Polymer-Coated Constant Stent (Cura™) in Acute ST-Elevation Myocardial Infarction: A Clinical and Angiographic Study (CURAMI Registry) |
| Chi-Hang Lee, MBBS, Jimmy Lim, MBBS, Adrian Low, MBBS, Xiao-Ling Zhang, MD, Than-Than Kyaing, MD, Mark Y. Chan, MBBS, Hwee-Bee Wong, MSc, Yean-Teng Lim, MBBS, Huay-Cheem Tan, MBBS |
ABSTRACT: Background. There are safety concerns over the current polymer-based drug-eluting stents (DES) on the possible delayed healing process and adverse reactions to the polymer when drug elution is completed. Cura™ (Orbus Neich) is a sirolimus-eluting, bioabsorbable, polymer-coated constant stent. Methods. From March 1 to June 30, 2005, Cura stent implantation was instituted as the default strategy for percutaneous coronary intervention in 49 consecutive ST-Elevation Myocardial Infarction (STEMI) patients (male 86%; average age 55 ± 10 years; diabetes 31%). Results. The angiographic success rate was 100%. In-hospital adverse events consisted of 1 in-hospital death (2% heart failure). A total of 27 patients (56%) underwent 8-month angiographic follow up. Binary restenosis occurred in 6 patients (22%), and late loss was 0.74 ± 0.89 mm. At 9-month follow up, a total of 5 patients had 6 major adverse events (1 death, 1 reinfarction, and 4 target lesion revasculari
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DK Crush (Double-Kissing and Double-Crush) Technique for Treatment of True Coronary Bifurcation Lesions: Illustration and Comparison with Classic Crush |
| Shaoliang Chen, MD, Junjie Zhang, MD, Fei Ye, MD, Zhongsheng Zhu, MD, Song Lin, MD, Shoujie Shan, MD, Tak W. Kwan, MD |
ABSTRACT: Background. Classic crush has a lower success rate compared to final kissing balloon inflation (FKBI). We previously reported the double-kissing (DK) crush technique that involves double-kissing along with double-crushing for the treatment of true bifurcation coronary lesions in 2005. Methods and Results. This is a consecutive, nonrandomized, open-label study. Eighty-eight consecutive patients with single, true coronary bifurcation lesions according to Lefevre Classification2 and side branch diameter >2.0 mm were enrolled. The first 44 patients (from October 2004 to January 2005) were assigned to the classic crush treatment arm and the next 44 patients (from February 2005 to June 2005) were assigned to the DK crush technique arm, respectively. Data within 30 days were analyzed. Patients in the DK crush group, compared to those in classic crush group, were characterized by longer lesion length in the side branch (13.5 ± 3.4 mm vs 7.8 ± 3.1 mm; p
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| Edo Kaluski, MD, Steve Tsai, MD, *Olga Milo-Cotter, MD |
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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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About HMP Communications
HMP Communications LLC (HMP) is the authoritative source for comprehensive information and education servicing healthcare professionals. HMP’s products include peer-reviewed and non-peer-reviewed medical journals, national tradeshows and conferences, online programs and customized clinical programs. HMP is a wholly owned subsidiary of HMP Communications Holdings LLC, which also owns the North American Center for Continuing Medical Education (NACCME). NACCME provides a wide array of accredited CME offerings with industry thought leaders participating in roundtable meetings, webcasts, symposia, conferences, seminars, podcasts and satellite programs. Discover more about HMP’s products and services at www.hmpcommunications.com. ©2008 HMP Communications |
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Release Date: December 8, 2006