Currently, percutaneous coronary intervention (PCI) worldwide is characterized by a liberal use of coronary stents. In developed countries, the average stent use is approximately 80%.¹ In the early days of stenting, unacceptable high early stent thrombosis rates were observed.² Intravascular ultrasound (IVUS) has played a key role in improving our understanding of stent thrombosis. Routine higher pressure inflation and/or dilation with a larger balloon in order to improve stent expansion were techniques employed as practical solutions.^3,4 The usefulness of IVUS to reduce restenosis is still a matter of debate — certainly in the era of drug eluting stents.^4–7 Left main (LM) stenting has become a popular alternative to surgical revascularization.

Balloon mitral valvuloplasty (BMV) is an effective method for treating rheumatic mitral valve stenosis, producing good short- and long-term results^1–2 that are comparable to surgical valvotomy.^3–4 Two BMV techniques have been extensively used: the Inoue balloon technique,⁵ and the transseptal over-the-wire balloon technique,^6–12 the latter of which predominantly uses double balloons (DBT).

In this issue of the Journal of Invasive Cardiology, Eeckhout, et al. have described the adjunctive use of intravascular ultrasound to guide stent implantation in the treatment of symptomatic, “unprotected” left main coronary artery disease. While the use of stents or IVUS to guide stenting of left main stem disease are not novel, the experiences described by these investigators raise many important technical issues related to the optimal use of stents for left main percutaneous coronary intervention (PCI).

Transfemoral coronary angiography is not always possible because of obstructive arterial disease, and following the procedure, hemostasis can be difficult to achieve. An alternative transradial procedure described by Campeau1 has been widely accepted both by operators and patients.² Using 5 or 6 Fr catheters, it has even replaced the transfemoral approach as the routine method in some centers. The benefits of transradial angiography include immediate ambulation and a low risk of bleeding, hematoma, and pseudoaneurysm. However, it is technically more demanding, and thrombotic occlusion of the small radial artery occurs in 1–6% of the patients.^2,3 Therefore, an abnormal modified Allen’s test, which indicates insufficient collateral capacity from the ulnar artery, is generally considered a contraindication to the transradial method.

Materials and Methods
Stent and stent coating. Stainless steel balloon-expandable stents (Jostent,™ Germany) were used for these studies. The bare stents, 16 mm long, were dip-coated in a biological polymer (SAE coating) or in a polymer/tacrolimus solution (200 µg/stent) for in vivo studies. In addition, 18 mm long bare stents were dip-coated in a polymer/tacrolimus solution to load 750 µg/stent of tacrolimus for in vitro release analysis.
The surface characteristics of the coated stents were examined by microscopy. The stents were sterilized using ethylene oxide before implantation in porcine coronary arteries.

Severe acute respiratory syndrome (SARS) is an emergent global threat caused by a novel coronavirus (SARS-CoV),^1–3 which had caused outbreaks worldwide in 2003 with substantial morbidity and mortality,^4–8 affecting over 8,000 patients and leading to 774 deaths.⁹ Meticulous infection control is required to avoid nosocomial spread of infection. Published infection control guidelines by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), however, have not specifically addressed infection control issues in cardiac catheterization laboratories (CCL),^10,11 in which positive pressure ventilation is the norm. Two out of 90 SARS patients managed in our institution in the 2003 outbreak had cardiac catheterization performed in the course of their illness. We report the planning, implementation, and outcome of infection control measures against SARS cross-infection in the CCL setting.

In 2005, we live in a world full of lurking danger with biological terrorism, antimicrobial resistance, and new virulent and deadly viruses, always threatening on the horizon. Since 2003, we have seen the emergence of SARS as a major worldwide public health problem. SARS has generated more than 3,100 scientific publications, ranging from the epidemiology¹ and microbiology² of the virus, to the psychological consequences of dealing with mass outbreaks.³ Although the bulk of reflections and recommendations are geared toward emergency departments, there is a clear impact on the entire hospital, including the diagnostic laboratories. In this month’s Journal, Tsui et al. describe their experience in the catheterization laboratory with two patients infected with SARS who underwent catheterization and coronary arteriography.⁴

It is well established that early angioplasty reduces mortality in acute ST-segment elevation myocardial infarction (STEMI).^1–5 As the benefits of primary angioplasty over thrombolysis are time-dependent, it is important to minimize door-to-balloon time (DTBT) in acute ST-segment elevation myocardial infarction (STEMI). Current JCAHO and CMS (Center for Medicare and Medicaid services) consensus standards suggest a maximum DTBT of 120 minutes for patients presenting with STEMI, also emphasizing that “[t]he earlier primary coronary intervention is provided, the more effective it is.”⁶ Our institution has set a goal of 90 minutes DTBT measured from arrival at the ED. Of the many steps required from the time of ED registration to balloon inflation in the catheterization laboratory (cath lab), activation of the cath lab team is a likely cause of significant delays, particularly when such activation requires the intercession of the invasive cardiologist.

The benefits of the transradial approach have clearly been documented in numerous studies in the past ten years.^1–9 Access site bleeding complication rates are lower and early ambulation results in a significant reduction in patient morbidity and a lower total procedure cost.^3,4 Both patients undergoing the procedure and staff caring for these patients overwhelmingly prefer the transradial approach.¹⁰
As a result of these benefits, there has been an increase in the use of the radial artery for interventional procedures worldwide in the past several years. This experience has led to an understanding of the problems and complications that can result from the transradial approach. The purpose of the present manuscript is to review these issues.

Patients with recurring symptoms of angina due to saphenous vein graft (SVG) disease pose a difficult and increasingly frequent challenge. In general, these patients are older and have more extensive and diffuse disease of both the native circulation and the SVGs than do patients who have not undergone coronary bypass surgery. Repeat coronary bypass surgery is an option, but it is technically more demanding, is associated with higher mortality and morbidity, and has less optimal, long-term clinical results when compared with first-time bypass operations.¹ Favorable results have been achieved by using balloon angioplasty for the treatment of discrete, short lesions in relatively new bypass grafts.