ABSTRACT: Objectives. This study was designed to assess the feasibility and safety of enoxaparin in combination with glycoprotein (GP) IIb/IIIa inhibitors during percutaneous coronary intervention (PCI) as part of an early invasive strategy in patients presenting with acute coronary syndromes (ACS). Background. Trials in patients with ACS have evaluated the utility of enoxaparin, adjuvant GP IIb/IIIa inhibitors with PCI, and an early invasive approach. Information about the combination of all three of these approaches, however, is limited. Methods. Forty-nine patients with ACS underwent cardiac catheterization, of whom 23 underwent PCI with enoxaparin and GP IIb/IIIa inhibitors. Results. The primary endpoint of the study, a composite of death, myocardial infarction or urgent revascularization at 30 days, occurred in 8% of patients undergoing PCI. There were no deaths. One patient received a blood transfusion. No other adverse events occurred.

Compared to unfractionated heparin (UFH), enoxaparin has many advantages in the management of acute coronary syndromes (ACS). Rapidly and reliably absorbed after subcutaneous administration, enoxaparin has pharmacodynamic and pharmacokinetic profiles that are much more predictable than UFH, leading to prompt and consistent levels of anticoagulation and no need for routine monitoring.^1,2 In addition, unlike unfractionated heparin, enoxaparin is resistant to platelet factor 4 (PF4) inhibition, is associated with less heparin-induced thrombocytopenia, does not activate platelets, preferentially inhibits factor Xa production, augments tissue-factor pathway inhibitor, and attenuates Von Willebrand factor release.

ABSTRACT: The success rate of percutaneous recanalization of chronic total occlusion remains low. The Safe-Cross wire, which utilizes the principle of optical coherent reflectometry for guidance and has the ability to deliver radiofrequency energy for tissue ablation, was evaluated in 21 patients. This wire was used only after conventional guidewire failure, except in 4 patients who had failed an interventional procedure 3 months to 2 years previously. Conventional guidewires were successful in 9, and the Safe-Cross wire was successful in 10 of the remaining 12, including those 4 with a failed previous attempt. The total success rate was 90% (19/21 patients). Technological improvement in the steerability of the Safe-Cross wire may help to improve the success rate further.

Key words: optical coherent reflectometry

Chronic total occlusions (CTO) account for 10–15% of patients undergoing coronary angioplasty. Recanalizing CTO has been a challenge to the interventional cardiologist because of the inability to visualize the vessel lumen and/or cross the hard fibrotic plaque. Success in treating CTO using conventional angioplasty techniques has been dependent on lesion and vessel characteristics and the skills of the operator and ranged from 25–75%.^1–3

ABSTRACT: Background. Recurrent restenosis following vascular brachytherapy (VBT) has been reported in up to one-third of the patients enrolled in clinical trials. The long-term outcome of repeat percutaneous intervention (PCI) after failed beta-brachytherapy is currently unknown. Methods. We retrospectively analyzed 97 consecutive patients undergoing percutaneous coronary reintervention after failed beta-brachytherapy at our institution (80.8% of all brachytherapy failures). Long-term incidence of major adverse cardiac events (MACE; death, myocardial infarction, target lesion revascularization) was assessed. Results. The procedure was successful in 90 patients (92.8%). A new stent was implanted in 72% of the procedures (sirolimus-eluting stent in 16.5%). After 3 years, survival was 94.3%, survival-free from myocardial infarction was 86.7% and MACE-free survival was 66.1%.

ABSTRACT: Ikari is a new guide catheter for transradial intervention (TRI) that produces stronger back-up force by utilizing an unfavorable angle between the subclavian and brachiocephalic arteries. We report the initial results of the Ikari guide catheter based on the experience of a single center. Six operators performed a total of 102 coronary interventions for 91 patients using the Ikari guide catheter, while 101 interventions were performed with the transfemoral approach (TFI) during the same period. A left Ikari catheter was used in 63 procedures, and a right Ikari catheter was used in 39. The success rate for the procedure was 97% with a 6 French Ikari catheter. All failures were due to tortuous brachiocephalic arteries. For the Ikari procedure, the average fluorescence time was 14.5 ± 9.5 minutes and the dye volume used was 153 ± 53 ml; these results were equal to or better than those of TFI during the same period (20.1 ± 12.2 minutes and 184 ± 61 ml, respectively).

ABSTRACT: We investigated the efficacy of percutaneous coronary intervention (PCI) in coronary thrombotic lesions according to the timing of the procedure. Eighty-two patients who underwent immediate PCI (IPCI) were compared to 24 patients who underwent PCI 4.9 ± 3 days after the diagnostic catheterization [delayed PCI (DPCI)]. DPCI was associated with a lower rate of thrombus-related angiographic events (4% versus 27%; p < 0.03), including coronary embolism (0% versus 7%; p = NS), no-reflow phenomenon (0% versus 8%; p = NS), acute closure (0% versus 10%; p = NS), stent thrombosis (4% versus 1%; p = NS) and residual thrombus (0% versus 17%; p = 0.03). No differences were seen in the hospital clinical outcome, including non-fatal myocardial infarction (4% versus 9%; p = NS), death (4% versus 0%; p = NS) or major bleeding (4% versus 3%).

Case Report. A 43-year-old man with hypertension, stress and family history for coronary artery disease presented at the Emergency Department one hour after the onset of chest pain with an acute anterolateral wall myocardial infarction (MI), for which he was treated with a full dose of abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) and 50 mg of recombinant TPA bolus (Reteplase,Centocor, Inc., Malvern, Pennsylvania), heparin (PTT between 60 and 90), aspirin, intravenous nitroglycerin, and lidocaine. In approximately 30 minutes, the pain was relieved and the ST-segment elevation resolved with appearance of Q waves in leads V1–3. The peak CK was 1,580 IU/L with an MB fraction of 165 IU. Diagnostic coronary angiography, performed on day 4 for recurrence of pain, revealed a total occlusion of the proximal left anterior descending artery (LAD) with an apparent huge thrombus with distal LAD filling from the right coronary artery (RCA) (Figure 1).

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ABSTRACT: Percutaneous closure of a patent foramen ovale or atrial septal defect using various closure systems is now considered an alternative to surgical therapy in selected patients with cryptogenic strokes. We report the case of a late protrusion of the umbrella of a CardioSEAL Occluder into the left atrium associated with occurrence of a stroke. No recurrence of symptoms was seen at six-month follow-up after reinstitution of clopidogrel in addition to aspirin.