Percutaneous coronary intervention (PCI) devices have been getting smaller, especially guide catheters. In the 1990s, an 8 Fr guide catheter was necessary for stent implantation in a simple coronary lesion. At present, a 6 Fr guide catheter is frequently used for drug-eluting stent (DES) implantation in Japan. Recent studies have shown that a 5 Fr guide catheter is effective for the majority of noncomplex, selected cases.^1–5 While small guide catheters are superior to large catheters in terms of a lower complication rate at the approach site,^6,7 a 5 Fr guide catheter has some limitations. For example, a 5 Fr guide catheter does not accept an Atlantis SR Pro (Boston Scientific Corp., Natick, Massachusetts) intravascular ultrasound (IVUS) catheter because the IVUS catheter is too large for the inner lumen of a 5 Fr guide catheter. However, the same IVUS catheter can pass through a 5 Fr guide catheter if the guidewire size is 0.010 inch.

Arterial remodeling is the geometric alteration of the arterial wall in response to atherogenesis. During the development and progression of atherosclerosis, the external elastic membrane cross-sectional area (EEM CSA) may increase (termed “positive,” “outward” or “expansive” remodeling) to accommodate an increasing plaque burden, especially during early stages of plaque accumulation.¹ Conversely, the EEM CSA may decrease (termed “negative,” “inward” or “constrictive” remodeling) to contribute to the development of significant stenoses.^2–4 Studies correlating intravascular ultrasound (IVUS) and clinical findings have suggested that positive remodeling (PR) in culprit lesions is more associated with acute coronary syndromes and events post intervention, while negative remodeling (NR) tends to be biologically inert or associated with stable symptoms.^5–7

Patients and Methods
We retrospectively reviewed all patients > 60 years of age who underwent percutaneous ASD closure under our supervision since 1998. All patients underwent baseline clinical and echocardiographic evaluation including intra-atrial shunt calculation. Transcatheter ASD closure was performed using the Amplatzer septal occluder (AGA Medical Corp., Golden Valley, Minnesota). Balloon sizing of the defect served to guide the selection of the appropriate device diameter.

Atrial septal defect (ASD) is the third most common adult congenital heart defect¹ and was described by Leonardo Da Vince in 1513 as “I have found from a, left auricle, to b, right auricle, the perforating channel from a to b.”² The majority of patients who have a hemodynamically significant ASD remain asymptomatic during the first decade of life but, later develop right ventricular failure, pulmonary artery hypertension, atrial dysrhythmias and thromboembolic events.^3,4 A number of studies have shown the effectiveness of ASD closure by the transcatheter technique in children and adults. In this paper the authors describe the closure of the ASD in the elderly (> 60 years) using the Amplatzer septal occluder. Transcatheter closure of the atrial septum requires an understanding of the anatomy of the atrial septum.

Recent studies have shown that late incomplete stent apposition (LISA) develops following implantation of conventional bare-metal stents (BMS), drug-eluting stents (DES) or adjunctive intracoronary radiation (IR).^1–6 While the clinical relevance of LISA remains somewhat controversial, several reports have suggested that LISA may be associated with adverse cardiac events, including stent thrombosis.^4,7,8 Intravascular ultrasound (IVUS) studies have demonstrated that morphological features of LISA range from subtle detachment of the stent strut(s) from the vessel wall, to prominent aneurysmal changes at the stented segment. In the present study, the morphometric features of LISA accompanying BMS, IR or sirolimus-eluting stents (SES) were compared using serial IVUS images, thereby addressing the underlying mechanisms of LISA that develop with various treatment modalities.

This issue of the Journal of Invasive Cardiology includes original research articles, a Rapid Communication selection, as well as the third update of The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report to help clinicians incorporate the 2007 ACC/AHA Guidelines into their treatment protocol. Also, please visit our digital issue to view this month’s case reports and an index to all articles published during 2007 in the Journal (www.invasivecardiology.com).

Transradial access has gained popularity over the past decade due to its benefits such as improved patient comfort and decrease in access site bleeding complications. It is limited by difficulties that arise as a result of spasm as well as anatomic variations. Radial artery occlusion is a fairly infrequent complication of transradial access.¹ It is clinically quiescent in properly selected cases and rarely results in ischemia. It is probably related to the size of the catheter,^2,3 and more likely related to the ratio of the arterial diameter to the sheath.⁴ Despite its benign clinical course, it makes transradial access impossible from that radial artery. Certain factors have been found to affect its occurrence.

Every year, more than 1 million patients are admitted to a hospital with a diagnosis of unstable angina or non-ST-elevation myocardial infarction (UA/NSTEMI).¹ Relative to acute ST-elevation myocardial infarction (STEMI), patients with UA/NSTEMI have a slightly higher 1-year mortality rate,² and constitute a significantly larger proportion of patients with acute coronary syndromes (ACS).³ During the course of their hospitalization, these patients will interact with many different healthcare professionals, be subjected to many different drugs, diagnostic and invasive procedures, and be moved through several different hospital units before being discharged on multiple different medications.