Invasive Cardiology Current Issue

Frequency and Outcomes of Provisional Glycoprotein IIb/IIIa Blockade in Patients Receiving Bivalirudin (full title below)

admin — Tue, 09 Jun 2009 14:43:35 -0400

Frequency and Outcomes of Provisional Glycoprotein IIb/IIIa Blockade in Patients Receiving Bivalirudin during Percutaneous Coronary Intervention

Provisional Use of Glycoprotein IIb/IIIa Inhibitors in the Era of Dual Antiplatelet Therapy — Do “Bailouts” Pay Off?

admin — Tue, 09 Jun 2009 14:52:14 -0400

The routine use of more potent antiplatelet and antithrombotic therapies led to substantial improvements in outcomes after percutaneous coronary intervention (PCI) and has contributed to the interventionist’s ability to treat more complex lesions in ever more challenging patient populations.

Predictors of Target Lesion Revascularization in Patients Undergoing Lower Extremity Percutaneous Interventions

admin — Tue, 09 Jun 2009 14:58:41 -0400

ABSTRACT: Background. Predictors of target lesion revascularization (TLR) have not been well defined in patients undergoing peripheral percutaneous interventions (PPI). In this study we analyze predictors of TLR in a consecutive cohort of patients from two medical centers. Methods. Data were extracted from a prospectively collected peripheral vascular registry. Of 105 consecutive patients (175 vessels) undergoing PPI, follow up was achieved in 104 patients (172 vessels) at 8.06 ± 4.51 months. Univariate analysis was performed between the groups with (n = 19, vessels = 25) and without (n = 85, vessels = 147) TLR. Logistic regression analysis was utilized to model for the predictors of TLR. Results. TLR occurred in 14% of vessels treated at 8.06 ± 4.51 months. By univariate analysis, vessels with TLR on follow up had longer treated segments (167.0 ± 139.16 mm vs. 98.49 ± 113.33 mm; p = 0.027), more severe lesions (91.96 ± 12.56% vs.

Gender Gap, Inflammation and Acute Coronary Disease: Are Women Resistant to Atheroma Growth? Observations at Autopsy

admin — Tue, 09 Jun 2009 15:15:49 -0400

ABSTRACT: Background. Gender differences that exist in patients with acute coronary disease (ACD) are unexplained. We sought to determine if these differences could be related to differences in the pathologic substrate found in the coronary arteries at the time of death. Methods. The hearts of 83 patients (64 men and 19 women) who died of ACD were obtained fresh and uncut at the autopsy table. The coronary arteries were injected with a colored barium gelatin mass. After formalin fixation, the epicardial arteries were dissected intact, decalcified and cut at 2–3 mm intervals, with all segments mounted for histologic study. The severity of luminal stenosis and the frequency of adventitial inflammation, intimal calcification and atheromas were determined microscopically for each segment. Plaque burden was determined histologically by assessing the severity of luminal stenosis for each coronary segment.

One-Year Outcomes for Recanalization of Long Superficial Femoral Artery Chronic Total Occlusions with the Viabahn Stent Graft

admin — Tue, 09 Jun 2009 15:25:10 -0400

ABSTRACT: Objective. The treatment of long superficial femoral artery (SFA) chronic total occlusions (CTOs) remains controversial. There are several percutaneous treatment options available for the recanalization of these lesions. Percutaneous transluminal angioplasty (PTA) alone, nitinol stents, and expanded PTFE-lined nitinol stents are all viable treatment alternatives to femoral-popliteal bypass surgery. There are, however, limited data on outcomes of patients with SFA CTOs undergoing endovascular treatment. This study was performed to evaluate the safety, efficacy and 1-year patency rates of the Viabahn (WL Gore and Associates, Flagstaff, Arizona) e-polytetrafluoroethylene (e-PTFE) stent grafts at a major medical center in Phoenix, Arizona. Methods. Thirty patients (32 limbs) were prospectively treated for activity-limiting claudication after failing medical therapy. These patients received traditional angioplasty and stenting techniques using the Viabahn e-PTFE stent graft.

The Treatment of Peripheral Vascular Disease: Scio me nihil scire

admin — Tue, 09 Jun 2009 15:28:07 -0400

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and is associated with a high risk of cardiovascular morbidity and mortality. Despite the magnitude of the problem, PAD is often poorly recognized in clinical practice. What is also clear is that the field of peripheral vascular disease treatment continues to be based on anecdotes, case series and small case-control and randomized trials that lack the power to truly guide clinical practice.

Acute Evaluation of the Mynx™ Vascular Closure Device during Arterial Re-Puncture in an Ovine Model

admin — Tue, 09 Jun 2009 15:32:53 -0400

ABSTRACT: Background. The Mynx™ vascular closure device (VCD) (AccessClosure, Inc., Mountain View, California) is used for extravascular closure of the common femoral artery (CFA) after diagnostic or interventional endovascular procedures. Although it is common clinical practice to re-puncture a CFA, for some VCDs, acute repuncture is discouraged, while for other VCDs the safety of direct re-puncture through a previously placed VCD is still in question. The objective of this preclinical study was to evaluate the acute performance of the Mynx device where direct re-puncture has occurred through the hydrogel sealant, followed by delivery of a second Mynx device to close the re-access puncture site. Methods. Two ovine models with a total of 24 punctures (12 sets of puncture and re-puncture) were used for this study. Success was measured utilizing angiographic and observational endpoints. Results.

Transcatheter Closure of Patent Ductus Arteriosus with a Self-Expanding Platinum-Coated Nitinol Device

admin — Tue, 09 Jun 2009 15:40:20 -0400

ABSTRACT: Background. An occluding device for closure of patent ductus arteriosus (PDA) was developed from meshed nitinol wires coated with platinum for prevention of nickel release after implantation. Objectives. Our purpose was to assess the immediate and short-term results of transcatheter PDA closure with this device. Methods. Sixty patients (13 males and 47 females) underwent catheter-based PDA closure. The age ranged from 9 months to 65 years, with a median age of 4 years. The weight ranged from 4.2– 65 kg, with a median of 15.2 kg. The mean PDA diameter at the narrowest segment was 4.7 ± 2.2 mm, with a range of 2.0–15.1 mm. Eighteen cases had serial blood samples for serum nickel analysis taken before and at 1, 3 and 30 days after device implantation. Results. The devices were successfully deployed in all 60 patients. There were no serious procedural complications.

Transcatheter Closure of Patent Foramen Ovale Associated with Atrial Septal Aneurysm with Amplatzer Cribriform Septal Occluder

admin — Tue, 09 Jun 2009 15:45:23 -0400

ABSTRACT: Objective. We sought to evaluate the short- and long-term outcomes of Amplatzer Multi-Fenestrated Septal Occluder Cribriform (AMF) device use in the percutaneous closure of patent foramen ovale (PFO) associated with atrial septal aneurysm (ASA). Background. Since patients with PFO, associated with ASA, are at higher risk of embolic events (EE), the AMF device might offer advantages in this subgroup of patients. Methods. Overall, 38 consecutive patients, with both PFO and ASA, underwent percutaneous closure of the defect with the AMF device, and the results were compared to those in 38 patients with PFO and ASA treated with the Amplatzer PFO device (APO). Death due to embolism, stroke or transient ischemic attack (TIA) were considered recurrent EE. Pre- and post-intervention shunting and 6-month residual shunting were evaluated echocardiographically with intravenous contrast injection. Results. The procedure was successfully completed in all patients in both groups.

Patent Foramen Ovale and Atrial Septal Aneurysm: Achieving Closure

admin — Tue, 09 Jun 2009 15:48:39 -0400

The debate continues in the cardiology community over indications of percutaneous closure of patent foramen ovale (PFO) with or without an associated atrial septal aneurysm (ASA). Observational studies with control cohorts have shown an association between unexplained ischemic stroke and PFO. Hazard ratios for a stroke in the setting of a PFO range from 1.46–1.64.1,2 with an increase in the odds ratio of 3.9 for experiencing a cryptogenic stroke.3 An ASA alone or in combination with a PFO appears to increase the odds ratio of a paradoxical embolic stroke by 4.3 and 33.3, respectively.3 The latter was further underscored by a prospective European study in which the incidence of recurrent ischemic events (stroke or transient ischemic attack) despite appropriate antiplatelet therapy at 1 year was 3.7% and 3.0% with and without a PFO (6.2% and 5.6% at 4 years), respectively, but 5.9% at 1 year if a PFO was associated with an ASA (19.2% at 4 years).4