ABSTRACT: Background. The long-term prognosis of diabetic patients with multivessel coronary artery disease (CAD) treated by surgical or percutaneous coronary revascularization is significantly worse as compared to non-diabetics. Lower rates of complete revascularization may be one factor that influences the poor long-term outcome in the diabetic population. Our study assessed the impact of complete revascularization on the long-term prognosis in diabetic patients with CAD treated by percutaneous coronary intervention (PCI). The study included 658 consecutive diabetic patients (mean age, 60.9 ± 10.1 years) who underwent PCI. Multivessel disease was present in 352 patients (53.5%). Revascularization was complete in 94 (26.7%) and incomplete in 258 (73.3%) patients with multivessel disease.

Percutaneous coronary interventions (PCI) have been increasingly adopted for the treatment of coronary artery disease in patients with diabetes mellitus.

ABSTRACT: This study evaluated specially designed perfluorocarbon (PFC) emulsions as blood substitutes in case of induced ischemia of the left heart ventricle in healthy farm pigs. Two hundred milliliters of perfluorocarbon emulsion were infused while 200 ml of blood were simultaneously drawn. Radiographic contrast media were given to aid placement of balloon catheters in the left coronary artery. Histopathological analysis showed that right heart failure caused the deaths of both pigs. Particles (up to > 3 µm) of foreign body materials obstructed capillaries of all organs analyzed (heart, lung, liver, kidneys and spleen). Laboratory investigation showed severe interference between the PFC emulsion and radiographic contrast media, resulting in the deterioration of the PFC emulsion. The strongest interference occurred when PFC emulsion and Accupaque® interacted; particle size started at an initial 311 nm and went up to > 3 µm within seconds.

ABSTRACT: Although numerous studies have established the utility of 4 French (Fr) catheters for routine coronary angiography, its adequacy for automatic quantitative coronary analysis has not been previously assessed. Methods. In 32 consecutive patients, coronary angiography was performed sequentially with 4 Fr diagnostic catheters and 6 Fr guiding catheters after intracoronary nitroglycerin. A total of 43 lesions were evaluated for quantitative analysis using both types of catheter as scaling devices. Possible differences in the reference diameter, minimal luminal diameter and percent diameter stenosis were evaluated. All measurements were performed offline by the same operator and intraobserver variability estimation was performed by repeating the evaluation in 12 lesions randomly selected after 1 month. Results. The mean reference diameter was 2.98 ± 0.48 mm, mean minimal luminal diameter was 1.00 ± 0.52 mm and percent diameter stenosis was 67.1 ± 15.3%.

ABSTRACT: The aim of this study was to evaluate the feasibility, safety and efficacy of transcatheter closure of secundum atrial septal defects (ASD) in patients with complex anatomy. From September 1997 to July 2003, a total of 40 patients (median age, 34 years; 65% female) with complex ASDs, defined as the presence of a large defect (stretched diameter > 26 mm) associated with a deficient rim (n = 23); multiple defects (n = 8); a multi-fenestrated septum (n = 5); and defects associated with an aneurysmal septum irrespective of their size (n = 4) underwent closure. The Helex device was used in 4 patients and the Amplatzer in the remaining. Two devices were implanted in 2 patients each. Implantation was unsuccessful in 5 patients, with 4 having large defects associated with a deficient anterior rim and a floppy posterior septum. Occlusion was observed in 22/35 patients (63%) immediately after implantation and in 31 (89%) at a mean follow-up of 18 ± 9 months.

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Since the pioneering investigations by King, Rashkind and their colleagues^1–6 in mid 1970s of percutaneous device occlusion of secundum atrial septal defects (ASDs), a number of other investigators have designed and tested other devices as reviewed elsewhere.^7,8 The interventional cardiologist has therefore, lots of devices to choose from. But the selection of one device over the other is difficult because of lack of prospective randomized clinical trials.^9,10 Such trials involving all the eligible devices is necessary to provide accurate information on usefulness of the devices. The present medical, ethical, regulatory and economic considerations are unlikely to result in such clinical trials. Therefore, the choice of the device has to be based on results of large cohorts of implantations of individual devices, sponsored by the manufacturer of the devices.

ABSTRACT: Heart catheterization is frequently applied in patients with coronary artery disease for diagnostic and therapeutic implications. Using the femoral approach, post-procedure bed rest of 4–6 hours is recommended to prevent groin complications. This extended strict bed rest is associated with patient discomfort and increased medical costs, and interferes with more efficient catheterization laboratory management of referred outpatients. Accordingly, we tested a simple clinical approach to identify low-risk patients who may benefit from ambulation within two hours after sheath removal. Ninety-eight outpatients were stratified to early (time = 1.5–2.0 hours; n = 74) or conventional ambulation (time = 4–5 hours; n = 24) based on difficulties in obtaining arterial access, presence of oozing or hematoma after completing manual compression.

ABSTRACT: Transradial percutaneous coronary intervention (PCI) is a safe and effective method of percutaneous revascularization. However, there are no data on the efficacy of the transradial approach in left main (LM) PCI. We studied 80 patients (pts) who underwent LM PCI between February 1994 and January 2002, and compared the radial (27 pts) and femoral (53 pts) approaches. Patients were considered free of restenosis if they were free of angina and had a negative treadmill or nuclear imaging study 6 months post-PCI. Mean follow-up time was 27.4 ± 23.0 months. Reason for PCI (stable angina, unstable angina, acute myocardial infarction) and lesion location (ostial, mid, distal) were similar in both groups (p > 0.05), whereas mean ejection fraction was higher in the radial group (56.5 ± 11.1% versus 49.2 ± 14.7%, respectively; p < 0.05).

ABSTRACT: We describe a case of carotid artery restenosis following carotid artery stenting for treatment of post-endarterectomy stenosis. The goal is to highlight the risk of recurrent restenosis following endarterectomy. In this case report, we describe the use of cutting balloon therapy as a reasonable alternative to repeat surgical revascularization.

Key words: arteriosclerosis, cerebrovascular disorders, endarterectomy