Volume 14 - Issue 2 - February, 2002

Use of a 0.014´´ Guidewire for Cannulation of Left Coronary Ostium with a Difficult Anatomy

Timur Timurkaynak, MD, Haci Ciftci, MD, Atiye Çengel, MD

Engagement of the left coronary ostium is usually accomplished with the standard Judkins technique in the majority of patients without further manipulation.1 For the minority of patients with difficult anatomies, there is an enormous variety of catheters available with different sizes and unique designs.2–6 However, catheter selection in most labs may be limited to those most frequently used (i.e., Judkins, Amplatz, Multipurpose), resulting in inadequate imaging of the coronary arteries.
We report a case with a difficult left coronary anatomy in which the left coronary ostium could not be ...

“Cutting Balloon and the Three Burrs”: Treatment for Ostial Left Anterior Descending Artery In-Stent Restenosis

Serge Osula, MBBS, MRCP and David R. Ramsdale, BSc, MBChB, FRCP, MD

In-stent restenosis (ISR) is a difficult complication to treat, occurring in 15–35% of stents deployed for de novo lesions in native coronary arteries.1,2 The restenosis rate following therapy for ISR is as high as 54%.3 Thus far, there is conflicting evidence in the literature as to the most practical approach for treating in-stent restenosis. We report a case of a left anterior descending artery (LAD) ostial in-stent restenosis treated with a combination of rotational atherectomy and “cutting” balloon percutaneous transluminal coronary angioplasty (PTCA).

Case Report. A 58...

An Anomalous Left Coronary Artery Originating from the Pulmonary Artery in a 72-Year-Old Woman: Diagnosis by Color Flow Myocardi

David E. Kandzari, MD, J. Kevin Harrison, MD, Victor S. Behar, MD

An anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) is an uncommon congenital coronary abnormality, occurring in fewer than 0.01% of patients undergoing diagnostic cardiac catheterization.1,2 Also termed Bland-White-Garland syndrome,2 ALCAPA is characterized by blood flow passing from a dilated right coronary artery to the left coronary arteries by collateral vessels and then passing retrograde to exit the anomalous left main artery into the pulmonary artery.
Usually identified during infancy or early childhood, ALCAPA is clinically manifest as ischemic...

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