Atherosclerosis, though a systemic illness, occurs at certain preferred sites, one being the ostia of the vertebral arteries.1 Narrowing of the vertebral artery origins, though often asymptomatic, can lead to devastating posterior circulation infarction.1–4
There is no generally accepted standard of care in treating vertebral osteal disease,5 but many physicians believe that conservative therapy with antiplatelet agents or anticoagulation offers the best outcome with the least risk to the patient. Endarterectomy and vessel bypass6 have

Despite the recent advent of drug-eluting stents (DES), preparation of complex lesions (e.g., ostial, diffuse, fibrocalcified lesions and in-stent restenosis) before stent implantation remains an essential component of percutaneous coronary intervention (PCI).1,2 Inadequate stent expansion has repeatedly been associated with restenosis and acute/subacute stent thrombosis.3–7 Pretreatment with ordinary balloon catheters has not been shown to improve immediate- and long-term results of PCI.8,9 Predilatation with high-pressure balloons may also l

Restenosis after percutaneous coronary intervention (PCI)occurs as a complex immune and proliferative response to injury. Even in the drug-eluting stent (DES) era, restenotic risk is not insubstantial, with reported rates of angiographic restenosis up to 18.9% and target vessel revascularization up to 12.1% in complex lesions or patients with diabetes mellitus.1 Among preventative strategies, focus on optimization of stent expansion with adequate lesion preparation and minimization of vessel injury with avoidance of balloon slippage (“watermelon seeding”) has led to deve

Vascular access site complications are common following cardiac catheterization.1 These complications, as high as 14% of patients undergoing percutaneous coronary intervention (PCI), increase hospital length of stay and cost.2 Accordingly, vascular closure devices (VCD) were developed to decrease these complications and the time-to-hemostasis and ambulation. Since their introduction in 1995, many improvements such as utilizing biologics (collagen, thrombin and others) have helped to address these needs. However, little has been done to address the infectious complicati

Coarctation of the aorta accounts for 5–10% of all congenital cardiovascular malformations and carries a high morbidity and mortality risk. Symptoms depend on the severity of the disease and other coexisting anomalies.

Case Presentation. A 52-year-old female presented with vague chest discomfort, increasing fatigue and exertional dyspnea. Her past medical history was significant for tobacco abuse and mild hypertension. Her physical examination was normal except for an apical gallop sound (S4). Her echocardiogram showed segmental wall motion ab

Case Presentation. A 13-year-old girl from very poor socioeconomic conditions presented with a 15-day history of chest discomfort and shortness of breath at rest. Her electrocardiogram (ECG) revealed Q-wave and ST-elevation in the chest leads suggestive of myocardial infarction (MI). She was admitted but not administered thrombolytics due to her late presentation. She was normotensive, non-diabetic and a non-smoker. The patient had a family history of coronary heart disease (CHD) (Figure 1). Her body mass index was 16.4 kg/m2. Echocardiography revealed

In the presence of concomitant significant ischemic mitral regurgitation (MR) and multivessel coronary artery disease (CAD), common practice is treatment with combined surgical mitral valve repair or replacement (MVR) and coronary bypass (CABG). Some have advocated revascularization with bypass surgery as a stand alone treatment for ischemic MR,1–3 however, these studies have mostly focused on patients with mild-tomoderate range MR. With the advent of drug-eluting stents (DES), the rates of restenosis and repeat target lesion revascularizations have significantly dropped.

Dear Editor:
Despite the fact that percutaneous mitral valvuloplasty (PMV) is a safe and effective therapy for the treatment of mitral valvular stenosis, one of the most important immediate complications of this procedure is systemic embolization (calcic or thrombotic). The incidence of cerebral embolization ranges from 0.5–5% of all PMV, although clinical expression is slightly symptomatic.1 We report an extremely rare clinical presentation of a neurological complication after a PMV.
Case Description. A 50-year-old female was referred to

We read with interest the article by Mishkel and colleagues1 along with the accompanying editorial in the August 2007 issue of the Journal of Invasive Cardiology. The authors compared short-term and 2-year outcomes of drug-eluting stents (DES) among patients with and without chronic kidney disease (CKD), and consistent with many previous studies, found increased inc idence of major adverse cardiovascular events (MACE) in CKD patients.
The study does not help readers with the choice of stent in CKD patients since the authors did not report outcomes of bare-metal ste

Aneurysms of saphenous vein grafts (SVG) to coronary arteries were first reported in 1975, but remain an unusual complication of coronary artery bypass graft (CABG) surgery.1,2 There are different, mostly surgical, treatment modalities, but in some cases percutaneous coil embolization, covered stent implantation and Amplatzer vascular plug occlusion have been attempted.3,4 We report on a case of a long SVG aneurysm 21 years after CABG surgery, which was treated with a Magic Wallstent (Boston Scientific, Maple Grove, Minnesota) and PTFE-covered stents.