Volume 18 - Issue 2 - February, 2006

Glycoprotein IIb/IIIa Inhibitors during Rescue Percutaneous Coronary Intervention in Acute Myocardial Infarction

Luis Gruberg, MD, Mahmoud Suleiman, MD, Michael Kapeliovich, MD, Haim Hammerman, MD, Ehud Grenadier, MD, Monther Boulus, MD, Shlomo Amikam, MD, Walter Markiewicz, MD, Rafael Beyar, MD

Fibrinolytic therapy for acute myocardial infarction, even with the most efficient regimens available, is fraught with a substantial proportion of failures to re-establish normal blood flow in the occluded vessel.1,2 Failure to achieve prompt and complete restoration of TIMI 3 coronary blood flow after full-dose thrombolysis is associated with a poor prognosis.3 Although percutaneous coronary intervention (PCI), with or without stenting following full-dose thrombolytic therapy (rescue angioplasty), is a common procedure in these patients, data are scarce and there is ampl...

Mechanical Reperfusion during Acute Myocardial Infarction in a Patient with Dextrocardia

Juan Zambrano, MD, Aristides De la Hera, MD, Eduardo De Marchena, MD

Case Report. A 53-year-old male with history of hypertension and hypercholesterolemia presented to the emergency room with new-onset chest pain for the last hour. Clinical examination was remarkable for a right-sided point of maximal impulse, with the liver edge palpable at the left side. His initial conventional electrocardiogram (ECG) showed decrease R-wave voltage throughout the precordial leads with ST-elevations in V1 to V3, as well as a negative P-wave in lead I (Figure 1), in contrast to his reversed dextrocardia ECG (changing precordial leads to the right, and flipping limb l...

Adjunctive Antiplatelet Therapy during Rescue PCI

John J. Young, MD and Dean J. Kereiakes, MD

The treatment of ST-segment elevation myocardial infarction (STEMI) continues to evolve due to the adoption of antiplatelet and anticoagulation regimens in combination with pharmacologic (fibrinolysis) and/or mechanical reperfusion. Rapid, complete and sustained restoration of infarct-related artery (IRA) blood flow and myocardial perfusion directly impacts patient outcomes, with improvement in left ventricular function and reduction in infarct size and mortality.1–5 Current fibrinolytic regimens appear to have reached a therapeutic ceiling, with normal (TIMI grade 3) IRA flow bei...

Sequential Balloon Dilatation for Combined Aortic Valvular Stenosis and Coarctation of the Aorta in a Single Catheterization Pro

Kursad Tokel, MD, Selman Vefa Yildirim, MD, Birgul Varan, MD, Enver Ekici, MD

Combined aortic valvular stenosis (AVS) and coarctation of the aorta (CoA) is uncommon.3–5 This combination was detected in 7% of a large group of children with CoA who underwent balloon angioplasty.2 The long-term results of percutaneous balloon dilatation for isolated AVS and isolated CoA are favorable, and this treatment is widely used today, particularly for palliation.3–5
In 1987, Pan et al.6 reported the initial results for 2 patients with combined AVS and CoA who were treated with sequential balloon dilatation during a single catheterizat...

Biodegradable Stents: They Do Their Job and Disappear

Ron Waksman, MD

Coronary stenting has become the default device in percutaneous coronary interventions (PCIs). Coronary stents are used as a mechanical means to overcome the major limitations of balloon angioplasty with enabling scaffolding and the prevention of early recoil and late vascular remodeling.1–3 The major limitations of stents are thrombosis and restenosis. While thrombosis has been controlled with the use of antiplatelet therapy, restenosis has been significantly reduced with the use of drug-eluting stents. Nevertheless, the role of stenting is temporary and is limited to the interve...

Percutaneous Retrograde Revascularization of Lower Extremity Vessels by Using the Dorsalis Pedis Artery: Two Case Reports

Ashish Awasthi, MD, Yassar Almanaseer, MD, Thomas LaLonde, MD, Thomas Davis, MD

Peripheral artery disease (PAD) is commonly found in association with coronary artery disease (CAD) and is also considered a marker for CAD.1,2 There has been an increase in the treatment options for PAD with an increasing number of endovascular options becoming available.3 PAD involving the lower extremities usually presents with claudication, or in more severe cases, with chronic limb ischemia. Endovascular therapy for PAD in the lower extremities requires angiography of the affected vessel, followed by appropriate percutaneous intervention, if indicated. The commonly u...

Coronary Bifurcation Stenting: From Crush to Culotte. Avoiding Limerence and Meme Propagation?

Roberto Baglini, MD, PhD, Duccio Baldari, MD, Giuseppe Mezzapelle, MD

The Wikipedia term “crush” refers to a short-lived and unrequited love or limerence (“to crush on”). The primary characteristics of limerence can be summarized as intrusive, perhaps obsessive thinking about the limerent object and acute longing for reciprocation. Limerent people can act as a reservoir of memetic ideas as expressed in Karl Popper’s Conjectures and Refutations (1963). From his point of view, theories that better survive the process of refutation are actually not more true, but rather, more “fit”.1 The limerent attitude of interventional cardiologists to ...

Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention

Srihari S. Naidu, MD and Shing-Chiu Wong, MD

Case Description. A 69-year-old female with hypertension and hyperlipidemia presented with a 2-month history of worsening exertional angina. Nuclear perfusion imaging indicated ischemia in the inferior and inferoposterior walls, with preserved left ventricular function. Coronary angiography was notable for severely calcified vessels and a right dominant circulation. The left anterior descending and left circumflex arteries were free of critical stenosis, but the right coronary artery was tortuous in its proximal segment, with a 99% mid-vessel lesion that appeared as a calcified, obst...

Saphenous Vein Graft Rheology Simulating a Thrombotic Lesion

Adrian F. Low, MD, Eugene Pomerantsev, MD, Margaret Ferrell, MD

Case Presentation. A 59-year-old male was admitted for accelerated angina. Serial ECGs and cardiac enzymes ruled out a myocardial infarction. He had undergone coronary artery bypass grafting 4 years before, as well as coronary stenting of an ostial circumflex lesion 1 year after his bypass. After the procedure, he was doing well until his most recent presentation to us. Diagnostic coronary angiography documented severe native coronary artery disease with in-stent restenosis of the previously stented circumflex artery. A focal lesion was noted at the ostium of the large first septal p...

Iodixanol and Chronic Kidney Disease

Gilbert Deray, MD

Dear Editor,

I read with great interest the Tadros, et al. article1 entitled Iso-osmolar Radiocontrast Iodixanol in Patients with Chronic Kidney Disease (J Invasive Cardiol 2005;17:211–215).

They concluded that the volume of iso-osmolar radio contrast does not affect the incidence of contrast-induced nephropathy (CIN) in diabetic patients with chronic kidney disease. They also compared the incidence of CIN with the use of iso-osmolar contrast iodixanol compared to a similar historical control, and found a lower incidence of CIN with the former (57% versus 24%).


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