ABSTRACT: Catheter-based intervention in saphenous vein aorto-coronary bypass is an established approach. Even if effective, this treatment can be associated with a high incidence of procedurerelated complications, mainly because of distal embolization of atherosclerotic plaque. Both occlusion devices and filter-based protection devices have offered comparable results. In the case described below, two different lesions were treated in the same saphenous vein graft using a filter-based device for the proximal lesion and a proximal occlusion balloon for the distal one. J INVASIVE CARDIOL 2008;20:E180–E182

ABSTRACT: One of the most difficult challenges in interventional cardiology has been in finding the approach to treat chronic total occlusions (CTOs). Here we present a case of recanalization of an angulated, calcified CTO. The lesion presented difficulty due to the lack of guidewire support to facilitate crossing of the CTO. In our case, an uncommon approach using a dual-lumen catheter (Twin Pass) to support and direct a guidewire was attempted. This resulted in a successful percutaneous revascularization. J INVASIVE CARDIOL 2008;20:309–311

BSTRACT: This case report describes the nonsurgical management of a distal LAD perforation and is accompanied by a brief review of the different techniques available for sealing off a persistent leak in a perforated distal vessel. Coiling and embolic devices are particularly useful to seal distal perforations owing to their low profile and maneuverability. J INVASIVE CARDIOL 2008;20:E187–E191

ABSTRACT: Coronary stent fractures are very rare. The predisposing factors for stent fractures are excessive postdilatation, overlapping stents and a hinge site in a tortuous coronary artery. We report a case of very late (after 699 days), displaced, sirolimus-eluting stent fracture deployed at nominal pressures without postdilatation and at a non-hinge portion of the left anterior descending artery. J INVASIVE CARDIOL 2008;20:E195–E196 Key Words: stent fracture; restenosis; sirolimus

ABSTRACT: With advances in transcatheter treatment options, percutaneous device closure of ventricular septal defects has become a safe and practical alternative to surgical repair. While outcomes have been excellent, late complete heart bock has been documented during follow up of pediatric patients. We report a case of late complete heart block complicating percutaneous device closure of a ventricular septal defect in a 37- year-old woman requiring permanent pacemaker insertion. The patient underwent transcatheter closure of an atrial and ventricular septal defect in the context of treated pulmonary hypertension and significant intracardiac shunting. Seven months after the procedure, the patient was admitted with presyncope, with electrocardiographic monitoring confirming complete heart block. While previously only reported in the pediatric literature, awareness of the possibility of complete heart block should be considered during the late follow up of adul

ABSTRACT: The occurrence of a single coronary artery (SCA) is rare in the absence of other associated anomalies of the heart and is often detected incidentally during coronary angiography. This anomaly is usually benign and various types of SCA have been described. We report a rare type of SCA originating from the right sinus of Valsalva, with the left circumflex artery (LCX) continuing from right coronary artery (RCA) and hypoplastic left anterior descending artery (LAD), which was incidentally found in a 63 -year- old female presenting as unstable angina. J INVASIVE CARDIOL 2008;20:E192–E194

ABSTRACT: We report a case of successful TandemHeart implantation for cardiogenic shock due to critical aortic stenosis using a 21 Fr transseptal cannula which was safely advanced through an existing inferior vena cava (IVC) filter under fluoroscopic guidance. This supported the patient through balloon valvuloplasty and subsequent definitive surgical valve replacement. This report demonstrates that the IVC filter can be safely crossed with a sheath as large as 21 Fr in size. In addition, patients with an existing IVC filter requiring a TandemHeart percutaneous ventricular assist device should not be denied this device for fear of dislodging the filter. J INVASIVE CARDIOL 2008;20:E197–E199 Key Words: percutaneous; ventricular assist; inferior vena cava; transseptal; filter

BSTRACT: Retrograde recanalization of a mid-left anterior descending chronic total occlusion via an ipsilateral intraseptal collateral vessel was successfully completed in two cases where the antegrade approach was infeasible or failed in a previous attempt. J INVASIVE CARDIOL 2008;20:312–316

ABSTRACT: We present a case of a chronic total occlusion that required the use of a 5 Fr in a 6 Fr guiding catheter. The 5 Fr in a 6 Fr guiding catheter method allows ultra-deep seating to increase backup support and assist stent delivery. This technique was paramount in this case, as there were technical challenges with failure to track drugeluting stents due to vessel tortuosity and lack of support. J INVASIVE CARDIOL 2008;20:317–318

ABSTRACT: In a patient with acute myocardial infarction treated with primary angioplasty, a large amount of thrombus was removed from the middle segment of the right coronary artery using a Pronto V3 extraction catheter (Vascular Solutions Inc, Minneapolis, Minnesota). Repeat angiography revealed no significant residual stenosis and no further intervention was undertaken. J INVASIVE CARDIOL 2008;20:E177–E179 The benefits of adjunctive mechanical devices to prevent distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction (AMI) are still a matter of debate.

ABSTRACT: One of the commonly used parameters for evaluating aortic regurgitation is the rate of pressure decay data obtained from echocardiographic evaluation or cardiac catheterization. The measurement of the rate of equalization of pressure between the aorta and the left ventricle and its utility in the setting of aortic insufficiency has been validated. Intuitively, the Doppler equivalent, pressure half-time, is inversely related to the severity of regurgitation. However, this is a phenomenon dependent on multiple variables including blood pressure, heart rate, compliance of the receiving chamber, effects of vasopressors and the volume status of the patient. We report a case of unique hemodynamics obtained during cardiac catheterization due to low filling pressures that was further confounded by elevated systemic vascular resistance in a critically ill patient with angiographically severe aortic regurgitation. J INVASIVE CARDIOL 2008;20:E183–E186

ABSTRACT: Background. A variety of nitinol-containing devices for transcatheter closure of atrial septal defects (ASD) has been widely used. However, there is concern about the release of nickel after nitinol device implantation. In this study, a platinumcoated nitinol device was braided from nanoplatinum-coated nitinol wires in order to prevent nickel release. The serum nickel levels before and after device implantation and the 1-year results were evaluated. Methods. Thirty-one patients, aged 4–59 years, and weighing 13.7–90.0 kg, underwent transcatheter closure. Blood samples for serum nickel levels were taken before, 1 day, 1 week, 1 month and 3 months after implantation. Results. Twenty-nine (93.6%) patients had a successful implantation. The mean ASD diameter was 19.7 ± 4.8 mm (range 10–30 mm). Procedure-related complications included transient brachial plexus injury in 1 patient, and transient dysrhythmia in 4 patients. All 29 patients had complete closure within

ABSTRACT: Carotid in-stent restenosis is a potential long-term sequela that may occur after carotid artery stenting. We report a singlecenter experience with this procedure and reviewed the database for individual patient characteristics and possible management options. J INVASIVE CARDIOL 2008;20:286–291 Key Words: Carotid artery in-stent restenosis; carotid artery stenosis; carotid artery stenting; carotid endarterectomy

ABSTRACT: Background. While favorable changes in atherogenic lipids are indisputably associated with improved clinical outcomes, a similar correlation with quantitative coronary angiography (QCA) parameters is more difficult to document. Objective. To assess the relation between changes in lipid profile and parameters of coronary artery disease (CAD) extent measured by QCA. Methods. We evaluated 1315 patients enrolled in trials of atherosclerosis regression and correlated their lipid profile with annualized changes in CAD score (average minimal lumen diameter for all segments evaluated), cumulative stenosis score (sum of stenoses for all segments evaluated) and average plaque area for all segments evaluated. Results. During the study, average low-density lipoprotein (LDL) decreased by 28% (p < 0.001), and average high-density lipoprotein (HDL) increased by 8% (p < 0.001). There was no statistical correlation between annualized changes in CAD score and change in LDL (p =

ABSTRACT: The pattern of use of glycoprotein (GP) IIb/IIIa receptor inhibitors in peripheral percutaneous interventions (PPI) remains unclear. Data on patients who received GP IIb/IIIa inhibitors during PPI were extracted from a prospective registry that tracks demographic, angiographic and in-hospital outcomes of patients at 2 medical centers. Primary success was defined as establishing thrombolysis in myocardial infarction (TIMI) 3 flow and < 30% residual in vessels treated. Primary safety endpoints included death, unplanned amputation, vascular access complications, major bleeding and thrombocytopenia. Patients were divided into planned versus bailout use of GP IIb/IIIa inhibitors. A total of 46 patients (128 vessels) were included in this study. The procedure was performed emergently, urgently and electively in 13%, 26.1% and 60.9% of patients, respectively. The mean age was 70.9 ± 11.2 years and 52.2% of patients were males. The patients’ Rutherford-Baker Classes II

ABSTRACT: Background. Renal artery stent restenosis remains a significant impediment that in part is attributed to suboptimal stent deployment. We tested the hypothesis that optimal stent deployment during renal artery interventions can be achieved using the Metricath (MC) system, a balloon-catheter sizing device. M e t h o d s. The MC low-pressure balloon derives accurate vessel lumen dimensions from the three-dimensional reconstruction of volume of fluid and pressure within the inflated balloon. We systematically compared the final visual assessment of renal artery intervention with a subsequent MC minimal lumen diameter (MLD) in patients undergoing renal artery stenting. Results. Sixteen patients underwent angioplasty and stenting of 20 renal artery lesions. MC guidance resulted in adjunctive intervention in 90% of lesions, increasing MLD from 4.40 ± 0.77 mm before to 5.17 ± 0.82 mm (p < 0.001) after adjunctive intervention. The MC MLD to the angiographic reference ves

ABSTRACT: We describe our experience of patients, from December 2005 through May 2007 who underwent percutaneous coronary intervention (PCI) with severely depressed left ventricle systolic function and complex coronary lesions. The complex coronary lesions included multiple vessel coronary artery disease, left main (LM) coronary artery disease, calcified coronary lesions and bypass graft disease. All patients were clinically assessed to be at too high of a risk for circulatory collapse without maximal hemodynamic support while they underwent high-risk PCI. The TandemHeart percutaneous ventricular assist device (THpVAD) may be able to provide the necessary circulatory support required to enhance procedural success and patient safety during high-risk PCI. Methods and Results. We implanted the THpVAD in 6 patients who underwent high-risk PCI. There was unanimity among several physicians in our institution that each patient was an exceptionally high risk for circulatory colla

ABSTRACT: Objective. The objective of this study was to create a calcified total occlusion model in porcine coronary arteries using a catheter-based technique. Background. Chronic total occlusion (CTO) represents 10–20% of all angioplasty cases and remains a challenge for interventional cardiologists. One of the limitations to successful recanalization is the failure to cross the wire through the CTOs. Methods. Twenty swine underwent total occlusion creations in the coronary arteries. Via a carotid artery, previously prepared bone chips with absorbable sponge were delivered into the coronary arteries using catheter-based techniques. Twenty-eight days post creation, coronary angiography and histology were performed. Results. Twelve animals survived and 10/12 had successful total occlusions. There were successful total occlusions in 100% (8/8) of the left anterior descending coronary arteries in the animals that survived. Angiography showed visible calcified total occlusion

ABSTRACT: Notwithstanding the advances in technology in the field of interventional cardiology, treatment of chronic total occlusions (CTOs) remains a challenging obstacle, posing a considerable barrier to achieving successful complete revascularization. We are proposing a new classification system for an antegrade approach to treat CTOs that will enable interventional cardiologists to assess the technical difficulties as well as procedural risks prior to attempting percutaneous treatment of this complex lesion subset. Furthermore, this classification may be a useful tool from the research standpoint, particularly in assessing the impact of this classification on clinical success rates. J INVASIVE CARDIOL 2008;20:302–304 Key words: percutaneous coronary intervention, angiography, total occlusions

ABSTRACT: Myocardial ischemia has been associated with patent saphenous vein grafts (SVG) for reasons that may be attributable to graft-related endothelial dysfunction. Recanalization of the bypassed native coronary arteries may relieve the regional ischemia. In this clinical scenario, percutaneous coronary intervention (PCI) of the challenging chronic total occlusions (CTO) can be facilitated by a retrograde approach utilizing the SVGs as access conduits. Controlled antegrade and retrograde subintimal tracking (CART) is a technique developed to facilitate the recanalization of CTOs by aggressive wire manipulation from both ends of the lesions. Success rates of CART are high in experienced hands with few complications. We discuss 2 patients who presented with anginal symptoms, ischemia on stress nuclear scintigraphy and patent SVGs on angiography. After the corresponding native CTOs in the bypassed coronary arteries were successfully recanalized using the CART technique,

ABSTRACT: Background. Multiple primary and secondary prevention trials demonstrate significant reduction in adverse cardiovascular outcomes in patients with, or at risk of, coronary artery disease as a result of statin therapy. This study was conducted to determine whether statin use prior to elective percutaneous coronary intervention (PCI) is associated with lower procedural myocardial infarction (MI) and major adverse cardiovascular events (MACE) in the form of a meta-analysis. Methods. Trials were eligible for inclusion if they included patients who received a statin prior to PCI and if appropriate documentation of procedural MI was performed. Studies that included acute coronary syndrome patients were excluded. For each trial, the results immediately post intervention and at the longest follow up (up to 12 months) were extracted and analyzed based on an intention-to-treat principle. Six trials involving 2,996 subjects met the inclusion criteria for periprocedural MI