Spontaneous coronary artery dissection is a rare and often fatal cause of acute myocardial ischemia occurring predominantly in young or middle-aged and otherwise healthy patients. We report a case of spontaneous dissection of the left main coronary artery in a young woman who was successfully treated with percutaneous coronary stent implantation. J INVASIVE CARDIOL 2007;19:E18–E221

ABSTRACT: The TandemHeart™ is a recently-introduced percutaneous ventricular assist device that may be used for short-term hemodynamic support. Its utility has been shown for assisting the left ventricle in a variety of high-risk percutaneous interventions, in helping the left ventricle recover from myocarditis, in cardiomyopathies and in cardiogenic shock following acute coronary syndromes. Limited data exist on its applications in patients with right ventricular failure. We report our experience, possibly the first human case description, of a patient in cardiogenic shock secondary to severe pulmonary artery hypertension where the TandemHeart was used as a short-term hemodynamic support tool. J INVASIVE CARDIOL 2007;19:E226–E229

Device fracture or dislodgement is an infrequent complication of percutaneous coronary intervention. While uncommon, there are a number of well-described complications including perforation, thrombosis and arrhythmia. Several percutaneous retrieval techniques have been previously utilized. We describe the use of three standard 0.014 inch angioplasty guidewires to simply and effectively remove a fractured guidewire located within a distal coronary artery. Various methods of management available in cases of device dislodgement or fracture are discussed, as is the potential mechanism of guidewire fracture. J INVASIVE CARDIOL 2007;19:E230–E234

We describe a novel approach of using percutaneous aortic valvuloplasty as a bridge to percutaneous coronary intervention in a patient with refractory congestive heart failure, severe aortic stenosis, severe left ventricular dysfunction and severe 3-vessel coronary artery disease who was not a surgical candidate for aortic valve replacement and coronary artery bypass grafting. J INVASIVE CARDIOL 2007;19:E238–E241

A female patient with graft-dependent coronary circulation presented with vertebrobasilar insufficiency and NSTEMI (Non-ST Elevation Myocardial Infarction) related to a 100 percent stenosis of the left subclavian artery. Our review of the medical literature indicates that this is the first reported case in which a patient presented with an anterolateral NSTEMI and dizziness with subsequent angiographic evidence of both coronary subclavian and vertebral subclavian steal syndromes successfully treated with angioplasty and stenting of the left subclavian artery without any intervention in the coronary arterial tree. J INVASIVE CARDIOL 2007;19:E242–E245

ABSTRACT: Renal artery aneurysms are rare vascular anomalies in which rupture is associated with devastating consequences. Only a few reported cases involved percutaneous treatment. Recently, technological advances have expanded indications for percutaneous treatment of such complex peripheral lesions. Despite this, certain anatomical settings such as extreme vessel tortuosity or angulation of the afferent vessel continue to pose challenges. New steerable devices may play a crucial role in those cases where conventional techniques have failed. We report a case of successful percutaneous treatment of a renal artery aneurysm and stenosis in a young male using the Venture™ catheter. J INVASIVE CARDIOL 2007;19:E246–E253

ABSTRACT: We describe the use of stenting in multiple renal arteries with severe ostial stenoses. A 62-year-old male with long-standing arterial hypertension despite treatment with multiple antihypertensive medications and mild renal impairment, appeared to have 5 renal arteries, 4 of which had severe ostial stenoses. Successful stent implantation of these 4 lesions was performed in one session. At 3-month follow up, the patient did well with adequate blood pressure control. In conclusion, stenting of ostial stenoses in multiple renal arteries appears to be a feasible and useful option in patients with renovascular hypertension. J INVASIVE CARDIOL 2007;19:E235–E237

Calcified lesions are a cause of stent underexpansion, which significantly increases the subsequent risks of restenosis and stent thrombosis, even when drug-eluting stents are used. In this report, we describe how a novel balloon catheter, the SafeCut Dual Wire percutaneous transluminal coronary angioplasty catheter, enabled adequate dilatation in a calcified lesion that was unresponsive to conventional balloon catheters. J INVASIVE CARDIOL 2007;19:E254–E256

ABSTRACT: We present an unusual case of massive pulmonary air embolism during permanent pacemaker implantation. Head down position, precordial thumb and cardiac massage must be done immediately after the diagnosis of this life threatening condition. If these maneuvers are not successful, air suctioning with a largelumen guiding catheter may be effective and life saving. J INVASIVE CARDIOL 2007;19:355–356

Background. A series of thrombectomy and distal filter devices have been developed to limit distal embolization during percutaneous coronary interventions (PCI). Objective. To evaluate the feasibility of the combined use of thrombus-aspirating catheters and distal filter devices in patients at high risk of no-reflow. Methods. Thrombus aspiration (TA) and distal filter protection (DFP) were sequentially used in a series of patients undergoing urgent PCI within 48 hours of acute myocardial infarction (MI). Inclusion criteria were: (1) occlusion of the infarct-related artery; (2) at least 2 out of the 6 Yip’s classification features of high thrombus burden. Coronary angiograms were evaluated off-line to assess thrombus score, coronary flow and distal embolization in different phases of the procedure. Results. TA followed by DFP prior to balloon dilatation or stent implantation was successfully performed in 20 patients with acute MI due to occlusion of de novo lesions (80%) or in-stent

ABSTRACT: M-Guard is an ultra-thin polymer mesh sleeve attached to the external stent surface. It is designed to minimize distal embolization during coronary, renal, carotid and vein graft stenting. The polymer net could also serve as a platform for more uniform drug delivery. Aim. To evaluate coronary M-Guard stent deliverability and safety (stent thrombosis and restenosis) in comparison to bare-metal stents (BMS) in a porcine model of percutaneous coronary interventions (PCIs). Methods. Under general anesthesia using percutaneous technique, 6 swine received a total of 18 coronary stents: 5 BMS and 13 M-Guard-BMS. Quantitative coronary angiography (QCA) was obtained immediately prior to and post-PCI, and at 30 days post-stenting. At 30 days, all animals were sacrificed and hearts were sent to a core lab for coronary histology and histomorphometry. Primary endpoints were 30-day QCA percent diameter stenosis, late luminal loss and minimal luminal diameter (MLD). Secondary

ABSTRACT: Background. Randomized trials of drug-eluting stents (DES) excluded patients with severe renal insufficiency. We sought to evaluate the impact of baseline renal function on clinical outcomes in recipients of coronary DES. Methods. We retrospectively reviewed our hospital databases to identify consecutive patients who underwent DES implantations between May 2003 and December 2004, subgrouped among 4 ranges of glomerular filtration rate (GFR) between ≥ 90 ml/min and < 30 ml/min, in 30 ml/min decrements, and 1 group treated with long-term dialysis. Clinical follow up was obtained at 6 months, 1 year and annually thereafter. Results. Our study group included 2,758 patients with long-term outcomes recorded over a mean follow up of 706 ± 273 days. The rates of in-hospital adverse events increased significantly as GFR decreased, though no major adverse event occurred among the dialyzed patients. Actuarial survival analyses up to 2 years revealed significant betw

ABSTRACT: The intra-aortic balloon pump (IABP) is the most commonly used temporary cardiac assist device. The precise role and the mechanism of any benefit in high-risk patients undergoing percutaneous coronary intervention (PCI) have not been fully determined. We hypothesized that the use of an IABP following PCI in high-risk non-shocked patients would immediately increase coronary blood flow, tissue perfusion and hence preserve left ventricular function. Methods. Predefined high-risk, but non-shocked, patients were randomized to either an IABP or no IABP following PCI. Angiography was performed pre-PCI, immediately post-PCI and 10 minutes after the completion of the procedure. TIMI flow grade (TFG), TIMI frame count (TFC) and myocardial blush grade (MBG) were measured. Echocardiographic wall motion index (WMI) was measured on days 1 and 30 following PCI. Results. Of 33 patients, 17 received IABP and 16 did not. At final angiography, the TFG was 2.8 ± 0.7 and 2.9 ± 0.3

ABSTRACT: Background. The radial approach to cardiac catheterization is increasingly popular due to shorter procedural and recovery times and greater patient comfort. Methods. Comparative cost analysis between radial or femoral (with/without closure device) approaches were performed. Results. Radial (R), femoral (F), and femoral with a closure device (F ± C) approaches were used in 70, 62 and 49 consecutive cases, respectively. Group R had higher access equipment cost ($93.0 ± 9.5 vs. $40.5) in group F (p < 0.001), but lower catheter cost ($19.7 ± 12.7 vs. $31.1 ± 9.3; p < 0.001) than Group F, and lower contrast cost ($26.9 ± 17.0 vs. $42.9 ± 25.0) in Group F ± C (p < 0.001). There was a lower postprocedure recovery cost ($185.2 ± 52.7) in Group R compared to $337.5 ± 59.0 in Group F (p < 0.001) and $208 ± 70.4 in Group F ± C (p < 0.001), with a median recovery time of 126.0 ± 36.0 minutes in group R vs. 240.0 ± 42.0 minutes, and 150.0 ± 48.0 minutes in groups F and F ±