Drug-eluting stents have substantially reduced the restenosis rate.^1–4 However, restenosis after drug-eluting stent (DES) implantation is resistant to repeat percutaneous coronary intervention (PCI), and remains an important clinical problem.⁵ A detailed intravascular ultrasound (IVUS) analysis has shown that nonuniform strut distribution (NSD) may be associated with increased intimal hyperplasia after DES implantation.6 However, this particular finding has not been compared among various DES types. The purpose of this study was to compare the difference in strut distribution between Bx Velocity^® (Cordis Corp., Miami, Florida) and Express II (Boston Scientific Corp., Natick, Massachusetts) stents, platforms of two U.S. Food and Drug Administration (FDA)-approved DES (Cypher™ and Taxus^®) in a bench test model and in human clinical case experience.

Hemodynamically significant left ventricular outflow obstruction occurs in up to 25% of patients diagnosed with hypertrophic cardiomyopathy (HCM).^1,2 A resting left ventricular outflow tract (LVOT) obstructive gradient of 30 mmHg or greater, adversely affects prognosis. Indeed it significantly correlates with an increased risk of death or progression to decompensated cardiac failure.³ Nonpharmacological therapeutic options for these patients with persistent and severe symptoms include dual-chamber pacing, percutaneous alcohol septal ablation and surgery.

Patent foramen ovale (PFO) has been identified as a source of paradoxical embolism and cryptogenic stroke.¹ Percutaneous PFO closure seems to be a highly efficient and safe procedure for the prevention of interatrial shunting,² and is intended to reduce the recurrence of paradoxical emboli and cryptogenic stroke. Implantable PFO occluders of different types are of variably-sized (20–35 mm diameter) metal-containing devices. It is not clear whether implantation of these devices in the interatrial septum affects the motion of the nearby structures and biomechanics of the heart. Doppler tissue imaging (DTI) allows for the quantitative assessment of regional myocardial tissue velocities. We prospectively evaluated DTI parameters before and after percutaneous PFO closure in patients with an otherwise structurally normal heart.

Methods

Patients.

Following the reports by Webster,¹ Lechat² and their colleagues, suggesting a relationship between strokes in young patients and patent foramen ovale (PFO), Bridges and her associates from Boston,³ and we from Madison,^4,5 utilized trans-catheter occlusion of PFO with clamshell and buttoned devices, respectively, to prevent recurrence of cerebrovascular accidents presumably related to paradoxical embolism via the PFO. It should be noted that King and Mills⁶ used their device for this purpose more than a decade earlier. Percutaneous closure of PFOs was thought to be an alternative option to lifelong anticoagulation. Since the initial reports,^3–6 a number of other investigators, referenced elsewhere,⁷ have adopted the concept and technique.

Interatrial septal defects (IASD) have been associated with an increased incidence of cryptogenic strokes.^1–7 Percutaneous closure of these defects is now widely performed and the safety of this procedure has been established. It is unclear, however, how effective IASD closure is in preventing further recurrences of strokes or transient ischemic events (TIA) when compared to traditional treatment with anticoagulation. Observational data, however suggest that IASD closure in patients with a history of cryptogenic stroke reduces the frequency and intensity of migraine headaches (HA) in migraine sufferers.^8–12 In this study, we retrospectively reviewed our own experience with IASD closure and its relationship to the frequency and intensity of migraine HA in patients with a history of unexplained strokes or TIAs.

Despite great progress in reducing death from cardiovascular disease over the past few decades, coronary artery disease (CAD) remains the most common cause of morbidity and mortality in Western countries. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are alternative methods of revascularization in patients with CAD.¹ The mechanism leading to restenosis after balloon angioplasty includes elastic recoil and vascular remodeling.

Although sex differences in percutaneous coronary intervention (PCI) outcomes have been observed in earlier reports,^1–5 these differences were often attributed to the older age of the women.^2,3,6 However, coronary disease is increasingly prevalent at a younger age and is associated with worse consequences in young women.^7–10 Premenopausal women experience higher mortality both following acute myocardial infarction⁸ (AMI) and coronary artery bypass grafting (CABG).^9,10 Recently, using the National Cardiovascular Database, Abramson et al reported that women younger than 50 years of age also experienced higher mortality following PCI than men of similar age.¹¹ Since the prevalence of cardiovascular disease in women matches the prevalence in men by the fourth decade of life,⁷ confirmation of a sex difference in PCI outcome as early as in the fourth decade of life could have important clinical impl

Polymer-coated stents eluting either rapamycin or paclitaxel, drugs that prevent entry of VSMCs into the proliferative cell cycle and inhibit neointimal formation following arterial injury, have dramatically decreased the risk of restenosis following coronary stent implantation.¹ However, recent studies suggest that rapamycin- and paclitaxel-eluting stents are associated with a higher risk of delayed or late stent thrombosis compared to bare-metal stents.^2,3 These observations, as well as the possibility that resultant myocardial infarction associated with late stent thrombosis may be associated with increased mortality relative to the use of bare-metal coronary stents,⁴ have lead to the convening of an unprecedented review by the U.S. Food and Drug Administration Circulatory System Devices Panel on the safety of drug-eluting stents (DES).

Case Presentation. A 70-year-old male was admitted to our clinic with a diagnosis of severe hypertension, right carotid artery stenosis, recent right sylvian artery ischemic stroke, insulin-dependent diabetes mellitus and bilateral peripheral artery occlusive disease stage II Fontaine. Doppler ultrasound of the carotid arteries showed: (1) 90% stenosis at the origin of the right internal carotid artery due to a hyperechogenic plaque; (2) suspicion of left internal carotid artery total occlusion; (3) significant stenosis of both subclavian arteries; and (4) total occlusion of the right vertebral artery. Neurological examination revealed mild left hemiparesis and a computed tomography (CT) scan showed a scarred right sylvian stroke.

Case Presentation. This is the first report of spontaneous coronary artery dissection (SCAD) initially diagnosed by 64-slice multidetector computed tomographic angiography (CTA) (Figures 1–3). The patient was a 53-year-old male with prior myocardial infarction not treated with percutaneous coronary intervention, and increasing dyspnea on exertion. Following the diagnosis of SCAD by CTA, he underwent selective coronary angiography (Figure 1) and intravascular ultrasound (Figure 3), which confirmed the dissection. Successful stenting of the right coronary artery lesion was performed (Figure 1).