ABSTRACT: Ventricular septal rupture is an infrequent, but usually lethal, complication after myocardial infarction that typically occurs in elderly patients. Percutaneous closure of this complication has been performed in some cases with variable results. We report on the case of a 77-year-old female with a postinfarction ventricular septal rupture who underwent percutaneous closure using an Amplatzer device. Although the device was successfully deployed, the patient continued to have hemodynamic impairment and died within 48 hours. J INVASIVE CARDIOL 2008;20:E79–E81

ABSTRACT: Radial diagnostic angiography and percutaneous coronary intervention have been shown to be safe and feasible with fewer major complications in comparison with the femoral approach. Despite their safety profile, occasional vascular complications do still occur. We present a case of a brachial artery perforation treated successfully by the deployment of a covered stent designed for coronary intervention. We believe we are the first to describe this technique, which may provide an alternative to vascular surgery in such a situation. J INVASIVE CARDIOL 2008;20:E82–E83

ABSTRACT: A 2.5 x 32 mm Taxus Liberté stent was deployed at high pressure in the proximal right coronary artery (RCA) of a 71-year-old male patient, but the distal part of the lesion remained uncovered. A second stent (Driver 2.5 x 12 mm) could not be advanced through the first one and was withdrawn. The pullback traction resulted in dislodgement of the stent from its delivery balloon. Fluoroscopic examination suggested that the missing stent had traveled to the ascending aorta. Transesophageal echocardiography disclosed a dense, linear, mobile structure in the ascending aorta arising from the right coronary ostium. A 64-multislice computed tomographic scan revealed that both stents were entangled, with the first stent (Taxus 32 mm) elongated (approximately 90 mm in length), and the second one (Driver 12 mm) attached to the tail of the Taxus stent in the aorta. Stent retrieval was performed with a 15 mm snare loop catheter through a 7 Fr femoral sheath. Examination of the

ABSTRACT: We present the case of an 86-year-old female with stenosis of the anomalous left main trunk originating from a stenosed ostial right coronary artery. She underwent successful percutaneous coronary intervention using simultaneous sirolimus-eluting kissing stents (SKS) for anomalous bifurcating lesions. J INVASIVE CARDIOL 2008;20:E71–E72

ABSTRACT: Endovascular therapy is emerging as a minimally invasive therapy in the treatment of high-risk patients with abdominal aortic aneurysms. We report on an 81-year-old male who developed a large distal anastomotic pseudoaneurysm after undergoing surgical repair of an abdominal aortic aneurysm. The pseudoaneurysm was successfully treated by embolization utilizing a 15 mm Amplatzer® septal occluder device. J INVASIVE CARDIOL 2008;20:E77–E78 Key Words: aortic pseudoaneurysm; endovascular therapy; Amplatzer

ABSTRACT: Coronary artery anomalies occur in approximately 0.2–12.2% of the adult population.1 Origin of left anterior descending artery and left circumflex artery from the right coronary cusp is relatively rare. The case we present is unique in that all 4 vessels (right coronary, left anterior descending, left circumflex and atrioventricular nodal branch) take off from the right coronary cusp, making a quadrifurcation. In this case, the left main artery is also absent. To our knowledge, there are few published case reports of anomalous origin of left anterior descending artery, but the total absence of a left main artery and quadrifurcation are unique to our case. J INVASIVE CARDIOL 2008;20:147–148

ABSTRACT: Acute coronary syndromes have been described as potential complications of any type of anaphylactic reaction. The real pathogenic mechanism inducing acute myocardial ischemia in the setting of anaphylaxis is not yet completely understood. Some pathogenic mechanisms, like coronary vasospasm, plaque activation and systemic hypotension, have been suggested. The hypothesis of a central role of mast cell and inflammatory cell activation and release of potent vasoactive mediators, inducing the mechanisms mentioned above, is the mainstay of so-called “cardiac anaphylaxis”. Herein we have reported two cases of anaphylaxis-induced acute ST-segment elevation myocardial ischemia which occurred during coronary angiography. The first one was probably related to contrast media contact, the second one to latex glove contact. Both of them were treated with percutaneous coronary intervention that immediately resolved the myocardial ischemia. J INVASIVE CARDIOL 2008;20:E73–E76

ABSTRACT: Since the initial description of an atrial septal defect closure device in the mid-1970s by King and Mills, transcatheter closure of atrial septal defects using various devices has now become an established practice in many centers. These techniques have proven to be safe, cost-effective and favorably compared with surgical closure. Closure of ventricular septal defects is regarded as more complex. This article reviews several studies and includes our single-center data on 875 atrial septal defect and ventricular septal defect patients. J INVASIVE CARDIOL 2008;20:E93–E96

ABSTRACT: In 1969, German-born Andreas Grüntzig joined the Angiology Division at the Zurich University Hospital. He participated in the evaluation of continuous Doppler ultrasound in peripheral arterial and venous disease and discovered that the relaxation phase of the Achilles tendon reflex is prolonged during calf pain due to intermittent claudication. Soon he became interested in Dotter's technique of peripheral transluminal angioplasty (PTA) with coaxial catheters, learned the procedure from Eberhard Zeitler and developed a new balloon catheter consisting of polyvinyl chloride. He wanted to improve the results of PTA in intermittent claudication, rest pain and incipient gangrene and to minimize their complications. In February 1974 he successfully performed the first treatment in a patient with femoral artery stenosis. The catheter used had been built by him, Maria Schlumpf and their team on his kitchen table. One year later, he introduced a double-lumen version that

ABSTRACT: Since Andreas Gruentzig’s initial description of coronary angioplasty, a whole host of additional percutaneous therapeutics have been developed. Along with percutaneous therapeutics, there has also been tremendous growth in percutaneous diagnostic techniques and equipment. Additional tools have been added to the interventionalist’s armamentarium to help in the assessment of coronary disease at the time of catheterization. Despite the maturity of coronary angiography including quantitative coronary angiography, the coronary angiogram, because it is an anatomic “lumenogram”, has several limitations that are addressed by these newer techniques. J INVASIVE CARDIOL 2008;20:E88–E89

ABSTRACT: Background. Damage to the polymer coating on sirolimus-eluting stents (SES) may occur when it is delivered through complex lesions such as calcified lesions. The present study evaluated damage to the polymer of SES that could not be delivered into lesions. Methods. SES that could not be delivered into lesions were prospectively collected and examined using a scanning electron microscope. Results. There were 5 undelivered SES. In all cases, moderate or severe calcification with and without vessel tortuosity were reasons for unsuccessful delivery. Scanning electron microscopy demonstrated damage to the polymer of 4 out of the 5 undelivered SES. Conclusion. Damage to the polymer coating of SES may occur when delivered through a calcified coronary artery. J INVASIVE CARDIOL 2008;20:130–133 Key Words: angioplasty; coronary artery disease; drug-eluting stents

ABSTRACT:We attempted to determine the incidence, timing and correlates of very early (< 24 hours) major adverse clinical events in patients undergoing contemporary percutaneous coronary intervention (PCI). Early discharge following PCI may offer significant advantages to patient and practitioner, but the timing of, and risk factors for, very early (< 24 hours) major adverse clinical events following PCI are not well characterized. A retrospective analysis of the CREDO trial was performed. A total of 1,815 patients underwent a PCI procedure and 139 patients (7.7%) experienced a major adverse clinical event (death, myocardial infarction or urgent target vessel revascularization) within the first 28 days. The majority of these events (111 patients) occurred within the first 24 hours, with the greatest risk of an event within the first 6 hrs. Multivariable predictors of very early events were age, AHA lesion grade, history of peripheral vascular disease, preprocedural TIMI f

ABSTRACT: Objectives. In our study we sought to determine whether mean platelet volume (MPV), measured on admission, could be used in determining decreased coronary blood flow (CBF) in stable coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Background. Platelets play a crucial role in the pathophysiology of CAD. MPV reflects platelet function and activity. There are no reports regarding the effect of MPV on CBF in patients with stable CAD undergoing PCI. Methods. A total of 66 consecutive patients (mean age: 58 ± 5 years, 74% male) with the diagnosis of stable CAD who were hospitalized for PCI were prospectively enrolled in our study. Coronary flow rates of all subjects were documented by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) for each major coronary artery before and after PCI. Blood samples for MPV estimation, platelet count and other laboratory data obtained on admission were measured on the day o

ABSTRACT: Objectives: We assessed the clinical, electrocardiographic (ECG) and angiographic characteristics of patients with acute coronary syndrome, increased troponin I (cTn-I) levels and normal creatine kinase levels. Background. Cardiac troponins are part of the new definition of acute myocardial infarction by the European Society of Cardiology and the American College of Cardiology. However, there are limited data regarding the angiographic characteristics of these patients. Methods. Between 1/2002 and 7/2004, a total of 50 consecutive cTn-I-positive, creatine kinasenegative patients were admitted to the intensive coronary care unit of our institution and underwent coronary angiography. Results. The mean cTn-I level was 10.7 ± 13.5 μg/L and the mean creatine kinase was 106 ± 40 U/L (normal < 180 U/L). Admission ECG showed inverted T-waves in 42% of patients, ST-segment elevation in 36%, ST-segment depression in 20% and a normal ECG in 20%. A total of 168 lesion

ABSTRACT: Objectives. This study compared acute and late outcomes following a strategy of selective drug-eluting stent (DES) use guided by a set of 4 criteria defining higher risk of in-stent restenosis compared to an exclusive DES strategy in 362 patients with multilesion (n = 900) percutaneous coronary interventions. Results. At a mean follow up of 412 ± 110 days, major adverse cardiac events (death, myocardial infarction, revascularization) were 16.8% in the exclusive DES group compared to 18.4% in the selective DES group (p = 0.78). By univariate analysis, revascularization rates (9.9% in the exclusive DES group versus 10.5% in the selective DES group; p = 1.0) and target lesion revascularization (TLR) rates (5.5% versus 6.2%; p = 0.77) were similar in the 2 groups. By multivariate analysis adjusted by propensity score to account for differences in baseline characteristics, the strategy of exclusive DES use was not associated with lower risks of revascularization (haz

ABSTRACT: Background. Large randomized clinical trials have demonstrated differences in the efficacy and safety of glycoprotein (GP) IIb/IIIa inhibitors, but little has been published regarding comparisons of these agents in a “real-world” setting. Purpose. This study evaluated the safety and efficacy of GP IIb/IIIa inhibitors in a large population of patients who underwent percutaneous coronary intervention (PCI) during a 5-year period. Methods. Patients undergoing PCI from 2000 through 2004 were eligible for inclusion if they received any single GP IIb/IIIa inhibitor. Patients with significant comorbidities were included. Patients were excluded if they received more than one GP IIb/IIIa inhibitor or underwent catheterization without PCI. Target activated clotting time was 200–250 seconds. Results. Of 5,055 patients undergoing PCI, 4,321 (85%) received a single GP IIb/IIIa inhibitor (abciximab, 1,178; eptifibatide, 1,698; tirofiban, 1,445). Major bleeding complications w

ABSTRACT: Objective. To evaluate the incidence of periprocedural creatine kinase-MB (CK-MB) release and its impact on longterm mortality in contemporary percutaneous coronary intervention (PCI) at a tertiary referral center. Methods. Retrospective analysis of 4,958 patients undergoing PCI with deployment of at least 1 stent at our center between January 1, 2003 and December 31, 2005. Patients admitted with acute ST-elevation myocardial infarction or cardiogenic shock (n = 617), and patients with no available CK-MB levels (n = 477) were excluded, leaving 3,864 patients for analysis. The outcome measure was all-cause mortality obtained from the National Strategic Tracing Service with patients followed up to June 30, 2006 (mean follow up 22 months). The association between CK-MB level and mortality was examined using Cox proportional hazards analysis. Results. CK-MB elevation above the upper limit of normal (ULN) was detected in 29.4% patients. A total of 127 deaths were ob

ABSTRACT: Background. Percutaneous coronary intervention (PCI) continues to revolutionize the treatment of coronary atherosclerosis and technologic advances require a preclinical coronary stenosis model. The purpose of this study was to systematically evaluate a porcine restenosis model of thermal balloon injury compared to stent overstretching. Methods. To evaluate this injury model, 22 swine were utilized. For the induction of coronary stenoses, the thermal balloon-to-artery ratio was equal to the range of 1.2–1.3 and was placed at a desired location in the coronary arteries, inflated with 2 atm, and heated to 80°C for 80 seconds. Quantitative coronary angiography was analyzed at baseline, immediately postprocedure, and 4 weeks at harvest. Quantitative coronary ultrasound analysis and histopathologic evaluation were also performed at 4 weeks postprocedure. Results. A total of 54 coronary arteries (thermal balloon injury [Thermo]; n = 43, coronary stenting [Stent]; n = 1