ABSTRACT: The use of distal embolic protection devices (EPD) in saphenous vein graft percutaneous interventions (SVG-PCI) has been associated with a decrease in adverse events. Currently, there are limited data regarding the percentage of SVG lesions that are suitable for EPD deployment. We retrospectively reviewed 131 SVG-PCI procedures occurring over 18 months for suitability for EPD deployment, utilizing previously published suitability criteria. We found that 49% of cases were suitable for EPD use, which is similar to results from other studies. Given the data supporting the use of EPD use in SVG-PCI, we feel that these findings should motivate interventional operators to establish benchmark standards for employing EPDs to improve the care of patients undergoing SVG-PCI.

J INVASIVE CARDIOL 2008;20:568–570

The Results of CTO New techniQUE for STandard Procedure (CONQUEST) Trial

ABSTRACT: The use of topical hemostasis patches has grown rapidly despite a paucity of evidence supporting their clinical utility. We performed a randomized, controlled trial to assess the efficacy of a topical hemostasis patch as a means to accelerate vascular hemostasis following percutaneous intervention. One hundred fifty (150) patients undergoing coronary or peripheral intervention through a 6 Fr femoral arterial sheath were randomized to sheath removal with either: (1) manual pressure and adjunctive use of a patch incorporating a polysaccharide based procoagulant material (SafeSeal Patch, Possis Medical Inc.); or (2) conventional manual pressure alone. Sheaths were removed when the activated clotting time (ACT) fell to ≤ 250 seconds. Patients ambulated 2 hours after hemostasis was achieved. Time to hemostasis (duration of compression required until cessation of bleeding following sheath removal) was significantly lower in the hemostasis patch arm (11.8 ± 3.6 vs.

The very nice study by Narins et al described in this edition of the Journal of Invasive Cardiology compares 75 patients randomized to vascular closure using a topical patch containing a polysaccharide-based procoagulant with 75 patients randomized to manual compression.1 Although the study found that those randomized to the patch had lower time to hemostasis and ambulation, several potentially confounding factors need to be kept in consideration.

The Different Patterns of Calcification of Acute Myocardial Infarction, Unstable Angina Pectoris and Stable Angina Pectoris

Coronary calcification has long been known to reflect underlying atherosclerotic coronary artery disease. In fact, the presence of coronary calcification has become an important component of screening for coronary artery disease and the extent of calcification on electron beam computed tomography has been shown to correlate with prediction of future cardiovascular events.1,2

ABSTRACT: Objective. To describe our institutional experience providing “hybrid” intraoperative stent therapy for pulmonary artery (PA) stenoses. Background. Surgical patch angioplasty, transcatheter stent therapy and intraoperative stent delivery are valuable treatment options for PA stenoses. The experience with intraoperative hybrid therapy has increased and new techniques and equipment have become available. Methods. This study involves a retrospective review of 20 patients with a median age of 5.1 years who underwent hybrid PA stent therapy between March 2003 and April 2008. Thirteen patients had underlying diagnoses of either tetralogy of Fallot, pulmonary atresia with a ventricular sepal defect (VSD) or truncus arteriosus. Results. In 15 procedures, stents were implanted under direct vision.

ABSTRACT: The pathophysiology of takotsubo cardiomyopathy remains enigmatic. Here we attempted to define the link between the coronary arteries and the histopathological involvement of the left ven- tricle. We observed similarities and discrepancies between patients. All patients experienced stress prior to the event. We found a reduced coronary flow reserve in all patients and signs of hibernating my- ocardium on biopsy specimen. This raises a strong suspicion of stress- induced endothelial dysfunction with hibernating myocardium in the pathogenesis of this cardiomyopathy.

J INVASIVE CARDIOL 2008;20:599–602

Case 1

In the Setting of ST-Elevation Myocardial Infarction

A Potential Role for Enoxaparin

ABSTRACT: Unfractionated heparin (UFH) is currently given as the standard anticoagulant therapy in ST-elevation myocardial infarction (STEMI) patients, including those undergoing percutaneous coronary intervention (PCI). Recent data, however, have shown lower rates of death or recurrent myocardial infarction (MI) with the low-molecular-weight heparin (LMWH) enoxaparin compared with UFH in STEMI patients treated with thrombolytics, offsetting an increase in major bleeding. This review compares the use of enoxaparin with UFH in STEMI patients undergoing PCI, within the context of available evidence for other anticoagulant drugs. Evidence is accumulating for the preferential use of enoxaparin in STEMI patients undergoing PCI.

J INVASIVE CARDIOL 2008;20:615–621