Suture-mediated closure devices have had extensive use for closure of arterial access sites using 6–8 French (Fr) sheaths.¹ Some experience with suture closure for large vessel arterial access has been described as well.^2,3 The utility of these devices for closing venous puncture is less well characterized.⁴ We have developed an experience using 6 Fr arterial closure devices for percutaneous closure of 14 Fr venous access procedures. The approach involves using “pre-closure”, which has previously been shown to be effective for closure of oversized arterial access with smaller sheath sizes.

Methods

Light-to-moderate alcohol consumption has been associated with a decreased risk of ischemic cardiac events and stroke.¹ The cardioprotective effects of alcohol have been attributed to favorable lipid changes, including lower LDL, increased HDL cholesterol and higher apolipoprotein AI and AII levels, antiplatelet, and anti-inflammatory effects.² Low levels of alcohol consumption have been proven beneficial in providing a protective effect upon the cerebral circulation. However, in heavy alcohol consumption, there is an increased predisposition to hemorrhagic and nonhemorrhagic stroke.³ The coronary protective effects of heavy alcohol consumption have not been well studied. Chronic heavy alcohol consumption is a well-known cause of dilated cardiomyopathy.

Although catheter-based brachytherapy has been demonstrated to effectively treat in-stent restenosis, a technique-dependent issue known as “geographic miss” has evolved as a potential limitation contributing to long-term treatment failures. The mechanism responsible for the unfavorable edge effects may include the combination of low-dose radiation and mechanical injury during the interventional procedure.^1,2 To ensure full coverage of radiation over the entire injured segment, longer radioactive seed trains have been recently introduced to interventional laboratories. This strategy, however, potentially leads to excessive radiation exposure to adjacent normal vasculature, especially the distal segment, due to the natural tapering of coronary arteries.

Recurrent unexplained syncope and presyncope comprise approximately 1–6% of emergency room and approximately 1% of hospital admissions.^1,2 The estimated incidence of self-reported syncope is 6.2 per 1,000 person years in the Framingham study.³ The overall incidence is approximately 3–6% over 10 years, and in a select group of patients, the prevalence of syncope could reach almost 50%.⁴ A symptom-rhythm correlation is often difficult to obtain during spontaneous episodes because of the sporadic, infrequent and unpredictable nature of syncope.¹ A significant percentage of patients referred for Holter monitoring, tilt-table test and electrophysiology study have inconclusive results. In addition, many of these patients also have a negative neurological workup.

Atherosclerotic peripheral vascular disease (PVD) is an underdiagnosed, undertreated, age-dependent, debilitating condition. Conservative estimates suggest that between 8 and 12 million people in the United States have PVD.¹ The incidence of intermittent claudication (IC) increases with age,² and the prevalence varies from 0.4% to 14% of the adult population.³ Furthermore, the prevalence of asymptomatic disease is greater than 25% in select populations, particularly the elderly.^4,5 Moreover, it is often underappreciated that the presence of PVD is a powerful and independent predictor of mortality.^6,7

Peripheral vascular disease (PVD) has been described as underreported, underdiagnosed and undertreated in this country. Clinical and epidemiological studies suggest the prevalence of PVD is higher than previously believed and could be over 20% in the general population.¹

Interatrial transseptal catheterization is a technique commonly used in the electrophysiology laboratory to access the left atrium. The procedure is being used more commonly as ablation of atrial fibrillation is more widely applied. Traditionally, transseptal catheterization has been done utilizing fluoroscopic markers with hemodynamic monitoring.^1,2 Different variations of the technique have been described. Recently, intracardiac echocardiography (ICE) has been used to assist in needle localization during transseptal catheterization.^3,4 Left atrial catheter ablation is frequently performed with use of one of several three-dimensional mapping systems available commercially. We describe a new technique that allows localization of the Brockenbrough needle tip within the cardiac images created in a three-dimensional nonfluoroscopic mapping system (EnSite NavX™, St. Jude Medical – Endocardial Solutions, St.

Pericardial effusions can result from various clinical entities. Occasionally, pericardial effusion may result in cardiac tamponade requiring immediate drainage. In some patients, especially those with malignant pericardial effusions, the effusions may recur and require further therapy other than pericardiocentesis.

Stent thrombosis is defined as acute thrombotic occlusion in the stented segment of a coronary artery, usually presenting as ST-segment elevation myocardial infarction,¹ and typically occurs within the first several weeks after stent placement. Stent thrombosis has traditionally been categorized as either subacute stent thrombosis (SAT), occurring within 30 days, or as late stent thrombosis (LST), occurring beyond 30 days.² While very late stent thrombosis (VLST), occurring beyond 1 year, has been increasingly described with the use of drug-eluting stents,3,4 thrombosis this late with bare-metal stents is very uncommon. We report a case of very late thrombosis of a bare-metal stent occurring 717 days after implantation.

Case Report. A 59-year-old male with exertional angina pectoris had undergone coronary angiography in 1998. Selective left coronary angiography showed that his left anterior descending artery (LAD) was totally occluded at the proximal site without any significant intercoronary collaterals, with a huge apical aneurysm on left ventriculography. Left internal thoracic artery (LITA) angiography was not performed. An *aneurysmectomy procedure with bypass grafting to the first diagonal and first obtuse marginal branch was planned. During the operation, only a saphenous vein graft was used for sequential anastomosis from the aorta to the first diagonal and first obtuse marginal branch with an apical plication procedure. The left internal thoracic artery (LITA) was not used as a graft and no anastomosis was applied to the LAD which was in the aneurysm area.