True bifurcation lesions, representing up to 16% of coronary targets for intervention, have been associated with higher peri-procedural complication rates and lower long-term patency rates.1–6 In the contemporary interventional era, several approaches have been proposed to treat bifurcation lesions.7,8 Coronary stents improve the immediate angiographic results by reducing lesion recoil and achieving better scaffolding, but stents are associated with increased thrombotic complications and later restenosis in bifurcation lesions.8–11 With different stenting approaches, there are 2 principal techniques frequently used: 1) stenting the main branch with balloon angioplasty of the sidebranch; or 2) stenting of both bifurcation branches.

The goal in treatment of ST-segment elevation myocardial infarction (STEMI) is rapid and complete reperfusion of the microvasculature. Optimal treatment strategies, however, are still being defined. Combined therapy (facilitated angioplasty) utilizing pharmacological agents for reperfusion followed by immediate percutaneous coronary intervention (PCI) has improved ischemic outcomes, but is associated with increased bleeding risk and no mortality benefit.1,2 Primary mechanical revascularization or primary PCI, when conducted in a timely fashion by experienced operators, is generally recognized as the reperfusion therapy of choice for STEMI resulting in 90% normal TIMI Grade 3 flow compared to approximately 60% with fibrinolytics.3–7

Coronary stenosis produces ischemia to the cardiac muscle by reducing blood flow. The anatomical and functional significance of coronary artery stenosis has been extensively studied.1,2
It is known that heat release is released from atherosclerotic plaques.3–6 Beating heart also produces energy leading to heat release, which is impaired in the presence of coronary artery disease (CAD). The impact of blood flow alterations, due to stenoses, on cardiac thermal homeostasis has not been elucidated. The aim of this study was to investigate whether acute interruption of blood flow may impair cardiac thermal homeostasis.
In order to investigate the role of blood flow changes on cardiac thermal homeostasis we performed coronary sinus thermography using a new thermography catheter developed in our institution in subjects without significant atheromatic lesions, in which acute interruption of blood flow in left anterior descending artery was performed with balloon inflation.

Reports of serious injuries and deaths associated with the use of hemostasis devices1 to the Center for Devices and Radiological Health (CDRH) of the Food and Drug Administration (FDA) provided the impetus for this study. These devices are primarily used to stop bleeding from the femoral artery catheterization site following cardiac diagnostic or interventional procedures. The most commonly used hemostasis devices provide two types of mechanisms for percutaneously controlling bleeding, either deploying sutures to close the femoral puncture site or re-absorbable collagen plugs to temporarily seal the arteriotomy, so as to allow the natural hemostatic process to take place.

Anomalous right coronary artery (AnRCA) from the left coronary sinus is found in only about 0.03–0.9% of patients undergoing coronary angiography.1,2 The AnRCA ostium originates either from within the left coronary sinus (Figure 1) or from the left aortic wall above the left coronary sinus (Figure 2). In either type, it is characterized by a course between the aorta posteriorly and the pulmonary trunk anteriorly (Figure 3) and is compressed by these structures. AnRCA is associated with sudden cardiac death during or after exercise, particularly in young athletes.3–7 Whether it also predisposes to early development of coronary artery disease (CAD) is still controversial.

Methods

Despite advances in hemostasis techniques, adjunctive devices and pharmacology, vascular complications from diagnostic and therapeutic cardiac catheterization occur in 2–11% of patients. Furthermore, these troublesome complications cause a significant degree of discomfort, morbidity and cost, and are associated with long-term adverse cardiac events.1 To date, it has not been clear whether women undergoing catheterization have the same vascular complication rates as men.

Coronary artery (coronary-cameral) fistula is an uncommon condition where an abnormal communication exists between a coronary artery and a cardiac chamber, pulmonary artery or systemic vein. Usually the termination is to the right side of the heart, occasionally to the left, and either the right or the left coronary artery may be involved.1

Percutaneous coronary intervention (PCI) is an effective treatment for myocardial ischemia in patients with coronary artery disease. More than one million PCI procedures were performed worldwide in 1998.1 A major limitation of percutaneous revascularization is the risk of acute ischemic complications associated with the procedure, including myocardial infarction (MI), urgent target vessel revascularization (TVR), and death. Approximately 10% of angioplasty procedures are complicated by one or more of these events.2 The timing of such events is crucial to understanding the pathophysiology of ischemic complications and determining the optimal duration of antithrombotic therapy. By using data from the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, we sought to determine the incidence, timing, and predictors of ischemic complications after non-urgent stent PCI.

Recent study of percutaneous intervention in chronic superficial femoral artery (SFA) occlusions indicates crossing the lesion is feasible in 68–100% of cases1–12 but that flow-limiting dissections and perforations requiring stenting occur at unacceptable rates. Ultimately, restenosis of stents placed across joints or to treat long lesions may limit the overall success of intervention.
A new catheter guidewire system (Safe-Cross RF TO Guidewire System, Intraluminal Therapeutics, Carlsbad, Calif.) (Figure 1) uses optical coherence reflectometry, a “forward-looking” fiberoptic guidance technology, to visualize total occlusions. In addition, the system contains a radiofrequency energy source that allows the operator to heat the tip of the guidewire to assist in crossing the occlusion.

Background and rationale. In delivering the prestigious 107th Shattuck Lecture to the annual meeting of the Massachusetts Medical Society (17 May 1997), Dr. Eugene Braunwald warned of two emerging epidemics of cardiovascular disease.1 One is atrial fibrillation (AF), now the most common cardiac arrhythmia, afflicting well over 2 million individuals in the United States alone.1,2 Indeed, the number of hospital discharges for AF more than doubled from 111,000 in 1984 to 270,000 in 1994.1 The prevalence of AF is likely to rise even more dramatically over the next several decades as the proportion of older individuals in the general population increases and as other non-cardiac risk factors for AF, such as diabetes mellitus, commensurately increase due to a worrisome rise in adult obesity.3