Editorial Message

Editor's Message

Dear Readers, This issue of The Journal of Invasive Cardiology includes original research articles, a rapid communication article, a case reports, two reviews, and articles from the journal’s special sections Adjunctive Therapy, Intervention in Peripheral Vascular Disease and Electrophysiology Corner. The Rapid Communication article, submitted by Dr. Woohyuk Song and colleagues from the Weill Cornell Medical College in New York, describes their development of a porcine coronary model for the study of chronic total occlusion. Preliminary results from their model indicate that the major areas of difficulty for percutaneous treatment are at the entrance and exit segments of the total occlusion. This model may provide valuable insight into treating one of the most challenging situations for invasive cardiologists. The first research article, submitted by Dr. Simcha Meisel and collaborators from the Hillel Yaffe Medical Center, Rappaport School of Medicine in Hadera, Israel, presents their study of the efficacy and safety of contrast injection beyond total occlusions in acute cardiac patients as a method of confirming balloon position in treating these difficult coronary lesions. They showed that their technique, which utilizes a soft-tipped guidewire supported by an over-the-wire balloon catheter through which dilute contrast is injected, was extremely effective in achieving proper position of the angioplasty balloon, especially in cases where exact position was uncertain. Next, Dr. Eui-Young Choi and associates from the Yonsei Cardiovascular Center, Yonsei University College of Medicine in Seoul, South Korea, present their research comparing a nonwoven, hydrophilic wound dressing to the RadiStop™ compression device in achieving hemostasis in the arterial access site following transradial percutaneous coronary angiography. They found that hemostasis was achieved much more quickly with the hydrophilic wound dressing without any increase in complications compared to the standard compression device. A research paper submitted by Dr. Joseph Germano and colleagues from Winthrop University Hospital in Mineola, New York, describes their evaluation of a novel, disposable, lead-free radiation protection a drape that can be effectively used to decrease radiation scatter during electrophysiology procedures. They demonstrated that this drape can significantly reduce radiation exposure to staff and operators during a variety of electrophysiology procedures. The next original research paper by Dr. Pragnesh Patel and colleagues from the Midwest Cardiovascular Research Foundation and Genesis Health System in Davenport, Iowa, presents their study to determine whether routine visualization of the left internal mammary artery prior to bypass surgery is necessary. They found that the LIMA rarely showed significant disease on pre-surgery evaluation, and that asymptomatic subclavian artery disease and the presence of lateral costal branches before bypass surgery did not correlate with post-CABG ischemia in the myocardium served by the LAD. The next original paper is also part of our Adjunctive Therapy section, which is edited by Dr. Deepak Bhatt, Director of the Interventional Cardiology Fellowship at the Cleveland Clinic Foundation. In this paper, Dr. Fausto Feres and colleagues from the Institute Dante Pazzanese of Cardiology in São Paulo, Brazil, report on their study involving angiographic and intravascular ultrasound findings of the “late catch-up” phenomenon after intracoronary beta-radiation for the treatment of in-stent restenosis. They demonstrated that this process of luminal deterioration can occur within stents at 5 to 12 months after brachytherapy. Dr. Raoul Bonan has also provided a commentary to accompany this article. We have two articles in our section entitled Intervention in Peripheral Vascular Disease, edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital/Medstar Health in Baltimore, Maryland. First, is a European registry-style clinical study assessing the performance of the SPIDER carotid filter when used as an embolic protection device during carotid intervention. Frank Criado, editor of our Intervention in Peripheral Vascular Disease section, reports that the outcomes were largely satisfactory and well in line with similar studies that have been conducted in Europe and the United States. Dr. Criado states that “The SPIDER filter is an innovative device that we had an opportunity to use during the feasibility and pivotal phases of the CREATE trial. It incorporates unique characteristics that would seem advantageous when compared with some other devices. FDA approval is expected in the course of this year.” Dr. Barry George has provided a commentary to accompany this article. Second, Dr. Frank Arena from the Pennisula Regional Medical Center in Salisbury, Maryland, discusses the problem of late occlusion and restenosis of nitinol stents used in the treatment of superficial femoral and popliteal arteries, speculating that this may occur from mechanical trauma that results from kinking of the stent due to bending of the leg. He suggests a method of testing this at the time of stent insertion as a way to avoid this long-term failure. In the last special section, the Electrophysiology Corner, edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York, Drs. Rolf Vogel and Bernhard Meier of the Swiss Cardiovascular Center, University Hospital Bern, present their approach in the emergent use of a guidewire to mechanically stimulate the right ventricular wall of a patient who developed complete atrioventricular block with asystole during catheterization of the right ventricle. This issue also includes a case report by Drs. Marcu, Israel and Donohue from the Department of Cardiology at the Hospital of Saint Raphael in New Haven, Connecticut. They discuss a patient who presented with acute myocardial infarction as a result of thrombus in the right coronary artery, and who was subsequently found to have extensive bilateral pulmonary emboli as well as deep vein thrombosis and a patent foramen ovale with atrial septal aneurysm. They describe their management of this complex patient who was at extremely high risk for recurrent embolic events. This issue of the journal is completed with two special review articles. The first review, submitted by Dr. Martin Lodge and colleagues, offers an excellent and succinct summary of PET and SPECT imaging, showing how these modalities are different and yet complementary, which may suggest an approach involving “hybrid imaging” in selected clinical scenarios. Next, Drs. Liuzzo, Ambrose and Coppola, present a comprehensive view of the mechanisms involved with activation of endothelial cells and the differential actions of sirolimus and paclitaxel on these processes. Their review provides key points in understanding why these two drugs exhibit different long-term outcomes. It is my hope that each of the articles in this issue of the journal will provide cardiovascular healthcare professionals with information that improves the daily care of their cardiac patients. Sincerely, Richard E. Shaw, PhD, FACC Editor-in-Chief