ABSTRACT: We describe the case of a 61-year-old male who had a critical stenosis of the left anterior descending artery (LAD). Intravascular ultrasound demonstrated that the LAD was attached to a large anterior interventricular vein (AIV). After stenting, a fistula was noted between the LAD and AIV, which was successfully sealed by deploying a covered stent. To our knowledge, this is the first case of iatrogenic arteriovenous fistula between the LAD and AIV that occurred following stenting of the LAD. J INVASIVE CARDIOL 2007;19:E188–E191

ABSTRACT: Hemolytic anemia related to intracardiac prosthetic materials has been described. We describe a case of a 74-year-old female with a history of hypertrophic obstructive cardiomyopathy that had a postoperative ventricular septal defect closed with a muscular ventricular septal defect occluder. The device caused intractable hemolytic anemia that required surgical removal and repair. We describe a rare cause of hemolysis complicating transcatheter closure of a post-traumatic ventricular septal defect. J INVASIVE CARDIOL 2007;19:E192–E194

ABSTRACT: We report the case of a 42-year-old female with proven anterior ischemia and an anomalous origin of the left main coronary artery (ALMCA) who underwent successful percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) guidance. Angiographic and IVUS images demonstrate features unique to the ALMCA. The epidemiology, pathophysiology, evaluation and management options, including technical considerations for percutaneous intervention, are discussed. The ALMCA from the right sinus of Valsalva represents one of the few potentially serious congenital coronary artery anomalies. These patients are often young, have atypical presentation and carry a risk of sudden death. In combination with unfamiliar anatomy and pathophysiology, they pose serious diagnostic and therapeutic challenges. We present our experience in a patient who underwent successful PCI with IVUS guidance, and discuss the anatomy, pathophysiology, evaluation and treatment opt

ABSTRACT: Acute aortic dissection during coronary arteriography is quite rare, but is a catastrophic and life-threatening complication. Patients in this clinical setting may have a potential risk for acute myocardial infarction requiring emergency life-saving surgery. Awareness of the problem and its prompt recognition are essential. We describe a case in which a right coronary artery (RCA) dissection occurred during diagnostic coronary arteriography and extended beyond the coronary ostium into the ascending aorta. Extension to the ascending aorta occurred during injections done for positioning of stents in the proximal RCA. Sealing of the aortic dissection and rescue of the RCA with stabilization of the patient was possible with rapid stenting of its ostium. J INVASIVE CARDIOL 2007;19:E199–E202

ABSTRACT: Spontaneous coronary artery spasm is an important cause of morbidity both in patients with atherosclerotic coronary artery disease and in those with Prinzmetal’s angina. Coronary vasospasm tends to occur in focal areas in the coronary tree and can be readily induced by the use of various agents. Spontaneous severe multivessel spasm, mimicking severe obstructive coronary artery disease, has been infrequently described. The therapeutic dilemma in such a clinical situation is highlighted in our current case where an unnecessary coronary artery bypass graft surgery (CABG) was performed due to the lack of clinical suspicion of spasm. This patient presented 5 years after triple-vessel CABG with an episode of rest angina, and was initially found to have severe obstruction of all three native coronary arteries with patent grafts to the right coronary and left anterior descending arteries. After nitroglycerin injection, all three native vessels appeared large and n

ABSTRACT: The incidence of air embolism during diagnostic cardiac catheterization and percutaneous coronary intervention is reported at a rate of 0.84% and 0.24%. Although there is no optimal technique to restore blood flow after blockage by air emboli, treatment options include manual aspiration or forcefully injecting saline, with auxiliary supportive measures like 100% oxygen or an intra-aortic balloon pump. The AngioJet (Possis Medical, Inc., Minneapolis, Minnesota) device is a catheter-based device for thrombus removal in which high-velocity saline jets are used to create a localized low-pressure zone at the distal catheter tip (Bernoulli effect), resulting in the maceration and removal of thrombus through an exhaust lumen. The use of rheolytic thrombectomy has been studied in thrombus-containing native coronary arteries as well as saphenous vein graft lesions. We report a case of a massive air embolus that occurred after activation of an AngioJet catheter in a

ABSTRACT: A 54-year-old male was admitted to our department for stable angina. Coronary angiography and 16-slice computed tomography revealed an abnormal origin of the right coronary artery from the left sinus of Valsalva, coursing between the aorta and the pulmonary trunk and then giving origin to the left circumflex coronary artery. A severe stenosis was present in the middle segment of the right coronary artery, which was successfully treated by stent implantation. J INVASIVE CARDIOL 2007;19:E185–E187

ABSTRACT: Percutaneous transluminal carotid artery stenting (CAS) is a promising new treatment option for carotid artery stenosis. These procedures are currently performed in high-risk patients and have demonstrated favorable outcomes. We described the use of intravascular ultrasound (IVUS) to facilitate internal carotid artery stenting in a patient with heavily calcified and ambiguous common carotid artery stenosis. The common carotid artery angiogram revealed 50% stenosis, but IVUS of the common carotid demonstrated a 90% stenosis with complex superficial calcification. Protrusion of the superficial calcification inside the common carotid artery which was demonstrated by IVUS has not only created a difficulty to deliver the stent to the internal carotid artery, but also left the common carotid artery lesion untreated, which is not likely to achieve clinical the benefit of internal carotid stenting. IVUS was an indispensable tool for a procedural success in this case. J

ABSTRACT: Reported are two cases in which stent protrusion from the right coronary ostium into the aorta caused considerable difficulty in interventions. Two different methods were applied to overcome this problem. In the first (elective) case a new orifice was created at the side of the protruding stent. In the second case (acute inferoposterior and right myocardial infarction associated with complete heart block, recurrent ventricular fibrillation and shock), a new track was created underneath the underexpanded protruding stent, and the protruding stent was crushed under a new stent. Stents protruding from the right coronary artery into the aorta may present a considerable challenge during interventions, which can be managed by certain technical modifications. J INVASIVE CARDIOL 2007;19:E207–E209

ABSTRACT: Angiographic no-reflow occurs occasionally during percutaneous coronary intervention in patients with acute myocardial infarction. Recently, we reported that coronary embolic particles can be detected as high-intensity transient signals with the Doppler guidewire. In the present study, the Doppler guidewire revealed that embolization of a cluster of embolic particles liberated by balloon inflation was responsible for angiographic no-reflow. J INVASIVE CARDIOL 2007;19:E210-E213

ABSTRACT: Development of coronary aneurysm following drug-eluting stent (DES) implantation has been increasingly reported in the last few years.1–6 Most of the authors cited local inflammation and hypersensitivity in the vessel wall as the primary etiology. We report a similar case of giant aneurysm formation following DES implantation. The unique feature of this case report is the systemic manifestations along with the presence of an intense local inflammatory reaction at the stent implantation site. J INVASIVE CARDIOL 2007;19:313–314

Background. Dual antiplatelet therapy reduces ischemic events after percutaneous coronary intervention (PCI) and in patients with acute coronary syndromes. The relationship between target vessel revascularization (TVR) and ischemic events in patients treated with aspirin and clopidogrel or aspirin alone from 1 month to 1 year after PCI has not been studied. Methods. Patients enrolled in the CREDO trial were treated with aspirin and clopidogrel or aspirin and placebo for up to 1 year. We compared the rates of TVR and ischemic events (cardiac death, myocardial infarction or stroke) in the two groups, and modeled the effect of clopidogrel treatment on ischemic events after adjusting for relevant parameters. Results. One month after PCI, 1,955 patients have remained asymptomatic. By 1 year, ischemic events occurred in 5.3% of placebo- and 3.1% of clopidogrel-treated patients; p = 0.02. The rate of TVR was 11.9% and 12.2%, respectively; p = 0.82. Only 7 patients (clopidogrel:

ABSTRACT: Background. Conflicting opinion exists regarding the optimal dose of acetyl salicylic acid (ASA) to be given after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We sought to evaluate the influence of ASA dose on the incidence of unexplained subacute and late stent thrombosis in the era of DES. Methods. We performed a retrospective analysis of the incidence of subacute and late stent thrombosis in our patient population over a 2-year period. The analysis was limited to patients being discharged and maintained on a daily ASA dose of either 81 mg or 325 mg and having received at least 1 sirolimus-eluting stent. Results. During the study period, 1,093 patients (1,807 separate PCI procedures) met the inclusion criteria. The incidence of unexplained subacute and late stent thrombosis was 1.1% in the study population (12 out of 1,093 patients). When considering the total number of individual procedures performed on the study population during

ABSTRACT: Transcatheter closure of patent ductus arteriosus (PDA) has been in place for more than three decades. We share our experience with the newer devices. Patients and Methods. Ninetyeight patients, with a mean age of 64 ± 11 months (range 7 months to 54 years), underwent attempted transcatheter closure of PDA. Thirty-seven patients were infants and 10 were adults. Two patients had residual PDA after surgical ligation. There were 66 females and 32 males. Results. Sixty-six patients were symptomatic and 32 were asymptomatic. Cardiac catheterization showed significant pulmonary hypertension in 18. The mean size of the PDA on aortogram was 3.1 ± 1.4 mm (range 1.1–11 mm). Seven patients were referred for surgical ligation. The PDAs of 37 patients were closed using coil devices, 52 with Amplatzer duct occluders (ADO) and two with Amplatzer muscular VSD devices. One patient had a very large PDA which was embolized and retrieved surgically. One patient required occlusion

ABSTRACT: Background. Despite the effectiveness of sirolimusand paclitaxel-eluting stents in reducing intimal hyperplasia (IH) and the need for repeat revascularization, concerns about their long-term safety have motivated the search for new drug-eluting stents (DES). Recently developed, the ZoMaxx™ stent combines a sirolimus-analogous agent (zotarolimus), featuring a phosphorycoline polymer and stainless steel and tantalum platform. We sought to assess the efficacy of this new DES in reducing IH. Methods. A total of 40 patients were treated with the ZoMaxx stent and compared to 50 patients treated with its non-drug-eluting equivalent, the TriMaxx™ stent. Only single de novo lesions in native coronary vessels ≥ 3.0 mm were enrolled. Serial quantitative coronary angiography and intravascular ultrasound (IVUS) images were obtained at baseline and 6- month follow up. All patients were clinically followed for 1 year. This analysis aimed to compare the percent of IH betw

ABSTRACT: Background. The role of different anticoagulants in reducing in-hospital complications in patients undergoing closure of interatrial septal defects (IASD) is unknown. In this study, we review our own experience with IASD closure data to determine if in-hospital complications and ambulation time are influenced by the use of various anticoagulants. Methods. Fifty-five consecutive patients with a history of unexplainable stroke or transient ischemic attacks (TIA), with the exception of the presence of an IASD, were included in this study. Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulants used pre- and postprocedure, anticoagulants used during the closure procedure, shunt grade across the IASD pre- and postprocedure, defect size, and right-sided filling pressures. Descriptive analysis was performed on all variables including complications frequency and ambulation t