CYPHER™ (sirolimus-eluting stent, Cordis, Johnson and Johnson, Miami, Florida) and TAXUS® (polymer-based paclitaxel-eluting stent, Boston Scientific Corporation, Natick, Massachusetts) stents are the two drug-eluting stents (DES) currently approved by the Food and Drug Administration (FDA) for clinical use. Both DES have been proven effective in reducing the risks of restenosis and repeat revascularization in simple coronary lesions.^1,2

The percutaneous treatment of bifurcation lesions remains suboptimal. A frequent problem, accounting for 10–20% of coronary lesions undergoing percutaneous coronary intervention (PCI), the bifurcation is plagued by acute technical challenges, long-term restenosis, and more recently, early and late stent thrombosis.^1–4 Generally defined as a lesion which involves a side branch of 2.0 mm or greater, the bifurcation is in part so complex due to its variability. This variability results from inconsistent plaque distribution, unpredictable side branch angulation and large differences in main branch and side branch diameters. Furthermore, these lesions are often noncompliant at the carina due to calcification and/or negative remodeling.

Low-molecular weight heparin (LMWH), especially enoxaparin, and unfractionated heparin (UFH), is recommended in the early medical management of acute coronary syndromes.^1,2 Compared to intravenous UFH, subcutaneous LMWH has a more predictable effect, a higher anti-Xa/anti-IIa ratio, does not require monitoring with an activated clotting time, and is resistant to inhibition by activated platelets.^3–5 Earlier work by Collet and Montalescot,⁶ as well as the recent, large SYNERGY trial⁷ documented the efficacy of transitioning high-risk acute coronary syndrome patients to percutaneous coronary intervention (PCI) after treatment with subcutaneous enoxaparin (1 mg/kg every 12 hours).

Over 500,000 coronary artery bypass grafts in 314,000 cases were performed in the United States in 2000, however, over half of all vein grafts develop significant stenosis within 10 years.^1,2 Percutaneous coronary intervention in saphenous vein grafts is consequently an increasingly common therapeutic modality utilized in the treatment of vein graft stenosis. In contemporary practice, vein grafts develop bulky lesions composed of loose atheroma and thrombotic material, and are often degenerated.³ This poses a significant risk for distal embolization and no-reflow, resulting in a major adverse event in up to 20% of procedures.⁴

Percutaneous transmitral commissurotomy (PTMC) has been established as an effective treatment for mitral stenosis (MS) and is now the procedure of choice.^1–6 Of the procedures available to treat mitral stenosis, percutaneous valvotomy using the Inoue balloon is well established and carried out worldwide.
The miniaturized metallic commissurotome devised by Cribier et al. is reported to be a reliable and effective alternative to balloon mitral commissurotomy.^7–11 The ease of resterilization and unchanged physical properties after multiple uses have made this device a promising alternative to balloon valvotomy, especially in developing countries that are forced, despite the inherent dangers, to reuse balloon catheters.

Fibrinolytic therapy for acute myocardial infarction, even with the most efficient regimens available, is fraught with a substantial proportion of failures to re-establish normal blood flow in the occluded vessel.^1,2 Failure to achieve prompt and complete restoration of TIMI 3 coronary blood flow after full-dose thrombolysis is associated with a poor prognosis.³ Although percutaneous coronary intervention (PCI), with or without stenting following full-dose thrombolytic therapy (rescue angioplasty), is a common procedure in these patients, data are scarce and there is ample controversy regarding the usefulness of the procedure.^4–6 Moreover, few data are available concerning the safety and efficacy of stenting in combination with glycoprotein (GP) IIb/IIIa inhibitors administration in these patients.^7–9 Even recent studies have failed to address the issue of GP IIb/IIIa inhibitor administration in these patients.¹⁰ The aim o

The treatment of ST-segment elevation myocardial infarction (STEMI) continues to evolve due to the adoption of antiplatelet and anticoagulation regimens in combination with pharmacologic (fibrinolysis) and/or mechanical reperfusion.

Combined aortic valvular stenosis (AVS) and coarctation of the aorta (CoA) is uncommon.^3–5 This combination was detected in 7% of a large group of children with CoA who underwent balloon angioplasty.² The long-term results of percutaneous balloon dilatation for isolated AVS and isolated CoA are favorable, and this treatment is widely used today, particularly for palliation.^3–5
In 1987, Pan et al.⁶ reported the initial results for 2 patients with combined AVS and CoA who were treated with sequential balloon dilatation during a single catheterization. Since then, only a few case reports have documented this combination of disorders and discussed treatment options and prognosis.^7–9
Here we present the immediate and long-term outcomes for a group of children with combined AVS and CoA who underwent percutaneous balloon dilatation in a single catheterization procedure.

Patients and Methods

Coronary stenting has become the default device in percutaneous coronary interventions (PCIs). Coronary stents are used as a mechanical means to overcome the major limitations of balloon angioplasty with enabling scaffolding and the prevention of early recoil and late vascular remodeling.^1–3 The major limitations of stents are thrombosis and restenosis. While thrombosis has been controlled with the use of antiplatelet therapy, restenosis has been significantly reduced with the use of drug-eluting stents. Nevertheless, the role of stenting is temporary and is limited to the intervention and shortly thereafter, until healing and reendothelialization is obtained. Beyond that, no utility or advantage for stents has been demonstrated and their presence could be a nidus for late thrombosis and chronic inflammation.

Why bioabsorbable stents?

Peripheral artery disease (PAD) is commonly found in association with coronary artery disease (CAD) and is also considered a marker for CAD.^1,2 There has been an increase in the treatment options for PAD with an increasing number of endovascular options becoming available.³ PAD involving the lower extremities usually presents with claudication, or in more severe cases, with chronic limb ischemia. Endovascular therapy for PAD in the lower extremities requires angiography of the affected vessel, followed by appropriate percutaneous intervention, if indicated. The commonly used access sites for lower limb interventions include the contralateral femoral artery, antegrade ipsilateral femoral artery, retrograde popliteal artery and sometimes even the brachial artery.