ABSTRACT: Endovascular treatment of vertebral artery stenosis and subclavian artery stenosis are low-risk procedures, but there are few reports of the best approach for subclavian-vertebral artery stenoses where there is an ostial stenosis of a vertebral artery that arises from a stenosed segment of the subclavian artery. This is a report of two cases with subclavian-vertebral artery stenosis that were treated with two different techniques. One-year follow up demonstrated widely patent stents. Also, to our knowledge, this is the first report of the use of the crush-stenting technique using drug-eluting stents in subclavian-vertebral artery bifurcation lesions.

ABSTRACT: We present the case of a young woman who developed an acute onset of classic cardiac symptoms, but because of her age and lack of risk factors, had a significant delay in transfer for cardiac catheterization. She was found to have spontaneous dissection of the left coronary system, eventually requiring emergent bypass surgery. The patient had recently began her menstrual period, and we speculate that hormonal fluctuations contributed to this process. The role of hormonal influences on the coronary vasculature is not entirely understood, but the incidence of spontaneous coronary dissection is higher in women, and is usually related to changes in hormones such as pregnancy and oral contraceptive use. We review the literature on spontaneous coronary dissection, the influence of hormones on the vasculature, as well as diagnosis and treatment options.

ABSTRACT: Tortuous or highly angulated vessels can sometimes be a hindrance to successful percutaneous coronary intervention while conferring an increased risk of major adverse events compared to lesions in nonangulated vessels. We present a case demonstrating the benefit of a recently available deflecting tip 0.014 inch guidewire to help negotiate an acute-angled takeoff of the left anterior descending artery from the left main coronary artery. This novel device proved successful, and as such, can complement the armamentarium of the modern-day interventionalist.

ABSTRACT: Stent dislodgement or loss in a coronary artery carries significant risks of infarction, thrombosis and requirement for emergency bypass surgery.1 Even with the advent of premounted stents, stent loss can occasionally occur, especially when performing intervention in calcified and tortuous anatomy. Multiple stent retrieval/stent exclusion techniques have been described to overcome this dreaded complication.2–7 We describe the first case of deploying a dislodged stent using a buddy wire technique with both wires through the center of the dislodged stent, and subsequent use of the small balloon technique to successfully deploy a dislodged stent in a heavily calcified and tortuous circumflex artery.

ABSTRACT: The use of drug-eluting stents (DES) provides early and late benefits demonstrated by angiographic and clinical outcomes. Here we report a case of late stent thrombosis and acute myocardial infarction caused by late stent malapposition (LSM) of a DES at 16 months after the procedure. We successfully treated the patient with balloon angioplasty after intravenous thrombolytic therapy. This case illustrates that a LSM can develop at any time after DES implantation and can result in acute coronary syndrome. Therefore, clinicians should be aware of the possibility of late cardiac events after implantation of DES.

ABSTRACT: Ruptured sinus of Valsalva aneurysm is a rare but well recognized clinical entity. These patients develop congestive heart failure due to biventricular increases in volume as a result of sudden aortocardiac shunting. Traditionally, surgical repair has been the mainstay of therapy. We report a case of a ruptured sinus of Valsalva aneurysm that was successfully closed percutaneously using the Amplatzer duct occluder in a critically ill patient operated on previously for coronary artery disease and presenting with acute congestive heart failure.

ABSTRACT: This report describes the simultaneous use of both peripheral and coronary distal protection techniques to prevent no-reflow phenomena in a large sequential saphenous vein graft. The use of a large peripheral stent allowed for simultaneous distal protection while advancing the larger-lumen stent over both wires, resulting in safe deployment.

ABSTRACT: A 70-year-old male patient with 90% stenosis of the right carotid artery and total occlusion of the left carotid artery underwent right carotid stenting. Two weeks after the procedure, the patient experienced grand mal seizures, and had angioplasty after 6 and 11 months, respectively, for recurrent in-stent restenosis. During drug-eluting stent deployment, the patient developed acute stent thrombosis, but he recovered quickly and completely after local thrombolysis and balloon angioplasty. For the 1 year of follow up to date, the patient has been sympto-free and without restenosis. At 6 months from the last-mentioned study, the patient was admitted for intermittent claudication, fatigability and severe hypertension. A Doppler study of the carotid stent showed normal velocities, and the the neurological exam was similar to the previous one. Angiography confirmed bilateral ostial stenosis of the renal arteries and we performed bilateral renal stenting at that time.

ABSTRACT: Background. Cell-specific inhibition of vascular smooth muscle cells, the primary constituent of neointima following arterial injury, without deleterious effects on vascular endothelial cell function may be a critical requirement for drug-eluting stents that are not prone to excess late thrombosis. We hypothesized that imatinib mesylate (Gleevec, Glivec, formerly known as STI571), a relatively selective inhibitor of protein tyrosine kinases including platelet-derived growth factor receptor (PDGFR), would inhibit hCASMC proliferation and migration in vitro with little effect on endothelial cell proliferation and prevent restenosis in a swine balloon injury model. Methods. Proliferation and migration of stimulated human vascular smooth muscle and endothelial cells were quantified in cell culture in the presence of imatinib (0.001–10 µM). Imatinib-loaded drug-eluting stents were implanted in swine coronary arteries after predilatation with an oversized balloon, and

ABSTRACT: Objective. To compare the difference of strut distribution between two clinically available drug-eluting stent platforms (Bx Velocity and Express II stents) using intravascular ultrasound (IVUS). Background. Nonuniform strut distribution (NSD) has been shown to be associated with increased intimal hyperplasia after drug-eluting stent implantation. Methods. IVUS imaging was performed on Bx Velocity (n = 6) and Express II stents (n = 6) after inflation pressures of 10, 16, and 26 atm in a bench test model. Percent NSD was defined as the length of segments with NSD (interstrut angle > 90°)/stent length. NSD was also assessed in postprocedure IVUS images in 53 clinical cases (32 Cypher, 21 Taxus) using 3-dimensional IVUS analysis. Results. Frequency of NSD segment and %NSD were lower in Bx Velocity stents than in Express II stents at the inflation pressures of 16 and 26 atm (%NSD: 16 atm, 0% vs. 13.8 ± 9.4%; p < 0.005; 26 atm, 1.1 ± 2.6% vs. 19.9 ± 6.9

ABSTRACT: Background. Left ventricular outflow tract (LVOT) obstruction in the setting of hypertrophic cardiomyopathy (HCM) confers negative adverse outcomes. Current nonpharmacologic treatment options include surgical myectomy and percutaneous transcoronary ablation of septal hypertrophy (TASH). While TASH negates a more invasive procedure, concern remains with particular regard to the arrhythmogenic potential of the resultant myocardial scar. Percutaneous transvalvular endomyocardial septal cryoablation (PTESC) may circumvent some of these potential limitations and offer a novel treatment strategy. Objectives. The purpose of this study was to report our early experience and outcomes with percutaneous endomyocardial cryoablation of the interventricular septum in obstructive HCM. Methods and Results. Between March 2005 and May 2006, 3 patients (2 male, 1 female) with symptomatic obstructive HCM underwent PTESC. Basal LVOT gradients measured during left heart cathet

ABSTRACT: Percutaneous patent foramen ovale (PFO) closure is performed for the prevention of paradoxical emboli. Doppler tissue imaging (DTI) was performed before and following transcatheter PFO closure in patients with an otherwise structurally normal heart to detect alterations in regional myocardial motion. The analysis revealed a mild, but statistically significant, reduction in the systolic motion of the basal interventricular septum. Other DTI parameters, including diastolic motion of the basal interventricular septum, systolic and diastolic motion of the left ventricular free-wall mitral annulus junction and the right ventricular free-wall tricuspid annulus junction, and the left ventricular cardiac performance (Tei) index remained unchanged. We found, thus, that transcatheter PFO closure does not cause major alteration in regional myocardial motion or cardiac performance.

ABSTRACT: Background. Recent data suggest that percutaneous closure of interatrial septal defect (IASD) is associated with a reduction in the intensity, frequency and duration of migraine headaches. In this study we review our own data to determine if we can reproduce the relationship between IASD closure in patients with a history of a central nervous system event (stroke or a transient ischemic attack [TIA]) and migraine headaches (HA). Methods. Fifty-eight consecutive patients with a history of unexplainable stroke or TIA with the exception of the presence of an IASD were included in this retrospective study. Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulant use pre- and postprocedure, shunt grade across the IASD pre- and postprocedure, defect size and right-sided filling pressures. All patients with a history of migraine HA answered the Migraine Disability Assessm

ABSTRACT: Although great progress has been made in reducing renarrowing of the lumen after stenting of coronary arteries, a considerable number of patients develop recurrent in-stent stenosis. Several studies suggest that neointimal proliferation is the crucial pathophysiological process underlying restenosis after stenting. The renin-angiotensin-aldosterone system (RAS) has been implicated in the development of neointimal hyperplasia. We tested the hypothesis that polymorphisms of the RAS genes are associated with recurrent in-stent restenosis (ISR). Coronary stent implantation was performed in 272 patients with clinical symptoms or objective signs of ischemia. At follow-up angiography 6 months after stenting, 81 patients (29.8%) revealed in-stent restenosis. These patients underwent balloon angioplasty and were scheduled for a further 6 months of follow up. One year after initial stenting of the coronary artery, 39 patients displayed no significant angiographic ISR, whereas 42

ABSTRACT: Background. Although sex-related differences in early outcomes have been observed in young women following acute myocardial infarction (AMI) and coronary bypass surgery, evidence for similar differences following percutaneous coronary intervention (PCI) is lacking. Methods. Using the 1999–2002 New York State PCI reporting system, we identified 11,162 men and 2,561 women aged 50 years or younger undergoing a first PCI procedure. In-hospital outcomes were compared by gender after multivariable adjustment for baseline, clinical and procedural characteristics. Results. Young women undergoing an initial PCI procedure were more likely to belong to racial or ethnic minorities and exhibit more comorbidities than young men. However, they had better ejection fraction (52.9% + 11.3 vs. 51.9 + 11; p = 0.0002) and presented more often with single-vessel disease (75% vs. 67%; p < 0.0001). Despite women receiving glycoprotein IIb/IIIa inhibitors (58.6% vs. 65.1%; p < 0.