ABSTRACT: Background. Ruptured plaques are associated with elevated C-reactive protein (CRP) that, in turn, are associated with a poor prognosis in acute myocardial infarction (AMI) patients. Objectives. The purpose of this study was to evaluate the impact of plaque rupture and elevated CRP on major adverse cardiac events (MACE) in patients with AMI treated with coronary stenting. Methods. We used pre-intervention intravascular ultrasound (IVUS) to evaluate infarct-related arteries in 72 AMI patients treated with coronary stenting to study the impact of plaque rupture and CRP levels on MACE. Results. Infarct-related artery plaque rupture was observed in 30 patients (42%), and multiple infarct-related artery plaque ruptures were observed in 10 patients (14%). The CRP level was higher in patients with plaque rupture than in those without plaque rupture (31.3 ± 20.3 vs. 4.2 ± 5.8 mg/l; p < 0.001).

References

ABSTRACT: Background. Transcatheter patent foramen ovale (PFO) closure can be performed with various devices. However, their handling, safety, presence of residual shunt and impact on recurrent thromboembolic events (TEs) are rarely compared with one another. Our goal was to compare the clinical performance of contemporary devices designed for PFO closure. Methods. PFO closure with the Cardia PFO occluder (n = 405), Intrasept (n = 301) and Amplatzer PFO occluder (n = 89) was attempted in 795 patients with presumed paradoxical embolism. Results. The procedure was successful in all patients. The periprocedural complication rate of 1.8% was comparable among the three groups. Residual shunting immediately following the procedure was higher in patients treated with the Cardia PFO occluder (24% vs. 14% [Intrasept] and 16% [Amplatzer]; p = 0.004). After a mean follow-up period of 26 months, no difference in residual shunting was seen (8% [Cardia] vs. 7% [Intrasept] vs.

The series of percutaneous closure of a patent foramen ovale (PFO) presented by the German institution represents one of the largest experiences worldwide.1 It is only natural that these pioneers of the Cardia device then moved on to its next generation, the Intrasept device. Curiosity obviously made them use as a comparator what they considered the best device other than their own. This is how the Amplatzer PFO occluder came into play.

ABSTRACT: Background. We designed a study to compare the novel point-of-care assay Hemonox clotting time (Hemonox-CT) with the activated clotting time (ACT) and anti-Xa activity to monitor the anticoagulation effects of enoxaparin and dalteparin during percutaneous coronary intervention (PCI). Methods. A total of 90 patients undergoing cardiac catheterization were assigned to intravenous (IV) enoxaparin 0.5 mg/kg, dalteparin 50 international units/kg or unfractionated heparin (UFH) 50 units/kg. We measured Hemonox-CT, ACT and plasma anti-Xa levels after serial sampling. Results. Baseline Hemonox-CT was similar in the enoxaparin (68 ± 9 sec) and dalteparin (68 ± 7 sec) groups with no detectable anti-Xa activity at baseline. Minutes after IV administration of enoxaparin and dalteparin, the mean Hemonox-CT increased to 171 ± 60 sec and 214 ± 70 sec for both groups, respectively. UFH induced a higher Hemonox-CT response (800 ± 243 sec).

ABSTRACT: Patients with large intracoronary thrombi represent a difficult management problem for the interventional cardiologist. We report 10 cases of challenging thrombi treated percutaneously using varying combinations of deep guide catheter engagement, guide aspiration, dedicated catheter aspiration and withdrawal of a distal filter vascular protection device. These cases demonstrate interventional options which may be considered for such patients.

J INVASIVE CARDIOL 2008;20:455–462

Key Words: coronary; thrombus; embolism; angioplasty; stent;
extraction; distal protection; filter

ABSTRACT: The role of endovascular therapy for the treatment of coronary and peripheral vascular diseases (including carotid, renal and lower extremity arteries) is expanding. The steady growth in the volume of endovascular procedures is likely to result in an absolute increase in the incidence of procedural complications. Knowledge of common and specific procedural complications and their management are critical to successful outcomes. Complications can be classified as (i) access site-related and (ii) systemic.

J INVASIVE CARDIOL 2008;20:463–469

The role of endovascular therapy for the treatment of coronary and peripheral vascular diseases (including carotid, renal and lower extremity arteries) is expanding. Knowledge of common and specific procedural complications and their management are critical to successful outcomes. Complications can be classified as (i) access site related and (ii) systemic.

ABSTRACT: We describe a case of a 51-year-old female who was incidentally noted to have a renal artery aneurysm on computed tomography (CT). The aneurysm was not seen on an abdominal CT performed 4 years prior, so the patient underwent successful percutaneous coil embolization. The indications for repair of such aneurysms are unknown, and there are a myriad of surgical and percutaneous management options. Because of the increase in abdominal imaging, the incidence of renal artery aneurysms is likely to rise. We describe the case and review the literature surrounding the epidemiology, outcome and management of renal artery aneurysms.

J INVASIVE CARDIOL 2008;20:470–472

Key Words: renal artery embolization; transcatheter coil embolization

ABSTRACT: Acute limb ischemia is a surgical emergency as a delay in reperfusion is associated with a high risk of irreversible tissue infarction potentially leading to limb loss and death. However, in medically compromised patients, perioperative morbidity and mortality remain high. An elderly woman with multiple comorbidities developed acute bilateral lower limb ischemia and was not felt to have a surgical revascularization option. Percutaneous restoration of reperfusion was successfully achieved by obtaining bilateral antegrade femoral arterial access followed by local infusion of fibrinolytic therapy and adjunctive thrombectomy resulting in bilateral lower extremity salvage.

J INVASIVE CARDIOL 2008;20:473–476

Key Words: acute limb ischemia; antegrade access; thrombolysis

ABSTRACT: Atherectomy using the FoxHollow device is an exciting treatment as an alternative to lower extremity arterial bypass for treatment of peripheral vascular disease in symptomatic patients with critical limb ischemia and disabling claudication. We present an interesting case of popliteal artery pseudoaneurysm following FoxHollow atherectomy, which is a rare complication. Mechanical factors have been implicated in causation of trauma to the vessel wall during atherectomy. Endovascular treatment of peripheral vascular disease has become increasingly common, thus it is important to know the rare complications associated with it. Pseudoaneurysm is one of the rare complications associated with the use of the FoxHollow atherectomy device.

J INVASIVE CARDIOL 2008;20:477–478