bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency Catheter Ablation of Septal Accessory Pathways
Authors: PFEIFFER DIETRICH , TEBBENJOHANNS JÜRGEN , SCHUMACHER BURGHARD , OMRAN HEYDER , FEHSKE WOLFGANG , LÜDERITZ BERNDT
Published: June 2007

Catheter ablation of septal accessory pathways in preexcitation syndrome is associated with special problems because of the risk of impairment of atrioventricular nodal conduction during ablation of anteroseptal and midseptal pathways. The complex morphology of the posteroseptal space has special problems for ablation with unclear location of the ablation catheter in the left or right atrial or ventricular cavum, in the coronary sinus, ventricular veins, or the neck of a coronary sinus diverticulum. Therefore, the visualization of the pyramidal space using echocardiographic investigations before the ablation procedure and retrograde coronary sinus phlebography during the ablation session has proven to be very helpful in placement of the electrode to the successful position. Reported herein are the techniques, results, and problems of radiofrequency ablation of 30 patients with septal accessory pathways compared to published data.
Elastic Recoil and Intimal Thickening After Coronary Stenting
Authors: UEDA YASUNORI , NANTO SHINSUKE , KOMAMURA KAZUO , KODAMA KAZUHISA
Published: June 2007

In this study, the long‐term elastic recoil of the stents and the intimal thickening over the stents were evaluated separately. Twenty‐nine patients who received a Wiktor coronary stent were angiographically followed‐up at 2 weeks, 3 months, and 6 months. The elastic recoil of the stent was evaluated by the changes in minimum stent diameter. The intimal thickness was evaluated by the difference between minimum stent diameter and minimum lumen diameter. Mininum stent diameter showed no significant change up to 6 months. The significant increase (P < 0.05) of the intimal thickness was detected only between 2 weeks and 3 months. In conclusion, the Wiktor stent prevented the elastic recoil up to 6 months, and was covered by the neointima which increased its thickness mainly between 2 weeks and 3 months after stenting. It was suggested that stent restenosis was not caused by the elastic recoil, but by the intimal thickening. (J Interven Cardiol 1995;8:137–141)
The Use of Intraaortic Balloon Counterpulsation in Acute Myocardial Infarction and High Risk Coronary Angioplasty
Authors: ARMSTRONG BRIAN , ZIDAR JAMES P. , OHMAN E. MAGNUS
Published: June 2007

Patients with complex coronary arterial stenoses, decreased ejection fraction, or acute myocardial infarction are at increased risk during percutaneous coronary interventions. Intraaortic balloon counterpulsation (IABP) can provide benefit in such cases by several mechanisms. Myocardial perfusion is improved and left ventricular afterload is reduced by balloon counterpulsation. Patients with cardiogenic shock clearly benefit from balloon counterpulsation until revascularization can be performed. Recent studies have documented the utility of balloon counterpulsation in patients undergoing angioplasty as treatment for an acute myocardial infarction. Balloon counterpulsation is also an effective means to reduce ischemia and provide hemodynamic support during complex percutaneous coronary interventions. This review will summarize the benefits, indications, and complications of balloon counterpulsation during acute myocardial infarction and high‐risk coronary angioplasty. (J Interven Cardiol 1995;8:185–191)
Intraluminal Palmaz Stent Implantation for Treatment of Recurrent Carotid Artery Occlusive Disease: A Plan for the Future
Authors: DIETHRICH EDWARD B. , GORDON MICHAEL H. , LOPEZ‐GALARZA LUIS A. , RODRIGUEZ‐LOPEZ JULIO A. , CASSES FERNANDO
Published: June 2007

While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primacy and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long‐term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69‐year‐old symptomatic man who required a third intervention for recurrent carotid disease. A > 90% stenosis of the distal third of his right common carotid artery was successsfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complicatons to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long‐term patency and may entail fewer procedural complications. (J Interven Cardiol 1995; 8:213–218)
Regional Flow Adjusted Hemoperfusion During Coronary Angioplasty: Circulatory Support/Myocardial Protection
Authors: OVERLIE PAUL A.
Published: June 2007

Routine percutaneous transluminal coronary angioplasty catheters are adequate and demonstrate high success rates in balloon angioplasty with stable patients. Active hemoperfusion seems to ofter an advantage in patients with hemodynamic instability. Active hemoperfusion provides myocardial protection during coronary interventions and can be applied in conjunction with routine angioplasty equipment. When compared with other devices demonstrating clinical utility in a supported angioplasty setting, this flow adjustable active antegrade hemoperfusion pump appears reliable, simple to use, cost‐effective, and requires much less instrumentation than the more bulky CPS systems. (J Interven Cardiol 1995;8:257–263)
The Role of the Perfusion Balloon Catheter After an Initially Unsuccessful Coronary Intervention
Authors: ARMSTRONG BRIAN , SKETCH MICHAEL H. , STACK RICHARD S.
Published: June 2007

Major dissection and acute closure following conventional percutaneous transluminal coronary angioplasty (PTCA) occur in 5%‐10% of cases and lead to significant morbidity. Newer percutaneous modalities such as directional coronary atherectomy (DCA), excimer laser coronary angioplasty (ELCA), rotational ablation, and transluminal extraction atherectomy (TEC) can also be complicated by dissection and acute closure. Redilatation with conventional balloon catheters can reestablish patency of the artery or improve flow in a minority of cases. The perfusion balloon catheter (PBC) has several advantages over conventional balloon angioplasty in this situation. In approximately 70% of these cases, subsequent use of a PBC yields an acceptable clinical and angiographic result. The PBC permits rapid resolution of ischemia caused by acute closure or a flow‐limiting dissection. New modifications of the PBC make it possible to position the catheter in nearly all segments of the coronary arterial tree including locations not accessible to other modalities, such as coronary stents or DCA, that are also used for salvage after a failed coronary intervention. Even if the PBC does not yield a definitive result, it allows rapid restoration of antegrade flow prior to coronary artery bypass grafting or coronary stent placement. Because of its ease of use, wide applicability, and efficacy, the PBC should be considered as the initial means of treatment in cases of major dissection or acute closure following any modality of percutaneous coronary revascularization. (J Interven Cardiol 1995;8:309–317)
Perfusion Therapy to Reduce Myocardial Ischemia En Route to Emergency Coronary Artery Bypass Grafting for Failed Percutaneous Transluminal Coronary Angioplasty
Authors: PAIK GEORGE Y. , KUNTZ RICHARD E. , BAIM DONALD S.
Published: June 2007

Despite improvements in operator technique, catheter technology, and the development of new devices, emergency coronary artery bypass grafting (CABG) is still required in 1%–4% of attempted catheter based revascularization procedures. Patients who require such emergency CABG after failed percutaneous transluminal coronary angioplasty (PTCA) have worse acute outcomes than those undergoing elective CABG, with a higher incidence of Q wave myocardial infarction (MI) and a higher operative mortality. In patients with otherwise refractory abrupt closure, maintenance of antegrade coronary blood flow using perfusion catheters lessens the incidence of Q wave MI and lowers peak creatinine phosphokinase. Direct maintenance of coronary flow thus appears to provide more definitive control of myocardial ischemia than purely adjunctive measures, such as intra‐aortic balloon pumping, cardiopulmonary support, or coronary sinus retroperfusion. Although the recent introduction of coronary stents holds great promise for definitive percutaneous reversal of abrupt closure and a dramatic decrease in the incidence of emergency CABG for failed PTCA, maintenance of antegrade flow via perfusion technology remains the cornerstone of management in reducing the perioperative mortality and morbidity of patients who still require emergency bypass surgery after failed PTCA. (J Interven Cardiol 1995;8:319–327)
BOOK REVIEW
Authors: Rottman Jeffrey
Published: June 2007

Cardiac Mapping, Edited by M. Shenasa, M. Borggrefe, and G. Breithardt.

Cardiovascular Medicine. Edited by James T. Willerson MD and Jay N. Cohn MD

Electrocardiographic Diagnosis of Tachycardias. By Clifford J. Garratt MD and Michael J. Griffith MD

ECG Board Review and Study Guide. By James H. O'Keefe, Jr, MD, Stephen C. Hammill MD, Mark Z. Zolnick MD, David M. Steinhaus MD, and Pierce J. Vatterott MD.

Cardiac Surgery, Biological and Psychological Implications. By Herman C.B. Denber MD, PhD

Beta3‐Adrenergic Agonism, A new concept in human pharmacotherapy. By Daniel E. Goldberg MD and William H. Frishman MD

Management of the Hypertensive Patient. By Lawrence R. Krakoff

Atrial Fibrillation, Facts from yesterday—Ideas for tomorrow. The Bakken research center series volume 8. Edited by Henri E. Kulbertus, MD, Hein J.J. Wellens, Ivan M.G.P. Bourtgeois MDc, MBA, and Rishcard Sutten, Dsc Med.

Radiofrequency catheter ablation of cardiac arrhythmias, Basic concepts and clinical applications. Edited by Shoei K. Stephen Huang MD

Reperfusion injuries and clinical capillary leak syndrome. Edited by B.A. Zikria MD, co‐edited by M.O. Oz MD and R.W. Carlson MD, PhD.
Balloon Aortic Valvuloplasty for Aortic Stenosis in Neonates, Children, and Young Adults
Authors: SANDHU SATINDER K. , SILKA MICHAEL J. , RELLER MARK D.
Published: June 2007

Balloon aortic valvuloplasty is a safe and effective treatment for aortic stenosis in neonates, children, and young adults. The indication for balloon valvuloplasty in children is a peak systolic gradient > 70 mmHg or > 50 mmHg in any patient with symptoms. Published results indicate that the procedure results in an acute reduction in gradient ranging from 49%‐70%, and this reduction appears to persist through at least an intermediate follow‐up. The percentage reduction in gradient is similar for neonates as well as older children. In neonates, it is imperative to evaluate the size of the left ventricle prior to balloon valvuloplasty since mortality is highest in those with variants of hypoplastic left heart syndrome. Though morbidity and mortality is higher in the neonatal age group, the results are similar to those following surgical intervention. In children older than 1 month of age, the major complication is the development of aortic re gurgitation, although it usually appears to be well‐tolerated. Previous surgical valvotomy is not a contraindication to balloon aortic valvuloplasty. In the current era, we believe that balloon aortic valvuloplasty should be considered as the first option in neonates, children and young adults with significant aortic valve obstruction. (J Interven Cardiol 1995;8:477–486)
Transcatheter Closure of Atrial Septal Defects
Authors: AUSLENDER MARCELO , BEEKMAN ROBERT H. , LLOYD THOMAS R.
Published: June 2007

The first transcatheter closure of an atrial septal defect (ASD) was performed by King and Mills in 1976. The Lock Clamshell occluder and the buttoned device are the latest devices to undergo clinical trials. Successful transcatheter closure has been possible with minimal morbidity and mortality. Small residual shunts may remain, however, in up to 20% of patients I year after the procedure. The clinical significance and natural history of these small residual atrial communications remains to be determined. This article reviews the history and development of the current ASD closure techniques, with emphasis on the experience with the Lock Clamshell occluder and the buttoned device. (J Interven Cardiol 1995;8:533–542)
Thrombogenesis in Acute Coronary Syndromes
Authors: CREA FILIPPO , FINOCCHIARO MARIA LUISA
Published: June 2007

It is well‐established that intracoronary thrombosis, which may be associated with plaque fissure and enhanced coronary vasoconstriction, is the immediate cause of a sudden impairment of regional myocardial perfusion, which is transient in unstable angina and is, eventually, irreversible in acute myocardial infarction. It is also well‐known that increased platelet reactivity, increased procoagulant activity, and reduced endogenous fibrinolysis are risk factors for acute coronary events. Nevertheless, the primary causes responsible for sudden intracoronary thrombosis and for coronary vasoconstriction causing acute coronary syndromes are still largely speculative. Recent studies have shown activated inflammatory cells both in the coronary arterial wall and in the systemic circulation of patients with unstable angina. Furthermore, the intensity of the inflammatory response is correlated with an adverse prognosis. This inflammatory component may have important pathogenetic and prognostic roles because an outburst of inflammatory cytokines has the potential to increase the sensitivity of platelets to agonists, to turn the anticoagulant and vasodilator physiological properties of the endothelium into procoagulant and vasoconstrictor properties, and to cause plaque fissure by the release of proteolytic enzymes.
Balloon Aortic Valvuloplasty in the First Year of Life
Authors: CARMINATI MARIO , GIUSTI SANDRA , SPADONI ISABELLA , REDAELLI SOFIA , BORGHI ADELE , BONHOEFFER PHILIPP , FIOCCHI ROBERTO
Published: June 2007

Between February 1988 and September 1993 balloon aortic valvuloplasty was attempted in 33 consecutive patients in the first year of life: 20 patients (61%) were younger than J month. Major associated anomalies such as mitral stenosis, coarctation, and hypoplastic left ventricle were found in 11 cases (33%). The balloon dilation of the aortic valve was accomplished through the right carotid cut‐down approach in neonates and patients with body weight < 5 kg, through a percutaneous femoral approach in the others; the procedure was completed in all. The peak systolic gradient across the aortic valve measured at catheterization fell from 80 ± 33 mmHg (range 25–165) before the dilation to 27 ± 17 mmHg (range 0–65), afterwards (P < 0.0001). The left ventricular ejection fraction increased from 44%± 26% to 61%± 17%, 24–48 hours after the procedure (P < 0.0001). Aortic insufficiency developed in 17 cases, being moderate in 2, mild in 6, and trivial in 9. Seven patients (21%), all in the first month of life, died within 30 days from the valvuloplasty; major associated anomalies were present in six; the death was due to a procedure related complication in one. No mortality was observed among the patients undergoing valvuloplasty beyond the first month of life. On follow‐up (6 months to 6 years) aortic restenosis occurred in 3 cases; 1 was treated by surgical valvotomy, 2 by repeat balloon valvotomy; in another 2 cases, a subvalvular aortic obstruction developed and was relieved by surgical resection. There was no late mortality. Thus, balloon valvuloplasty appears to be an effective palliation for critical aortic stenosis in infancy. Early mortality is mainly related to associated anomalies.
Indications of Implantable Defibrillator
Authors: COUMEL PHILIPPE
Published: June 2007

Implantable cardioverter defibrillators are devices capable of detecting and terminating ventricular tachycardias or fibrillations. They are utilized in the treatment of severe ventricular tachyarrhythmias, and their efficacy in the prevention of sudden death is demonstrated. As a matter of fact, despite the new antiarrhythmics available, and despite nonpharmacological therapies like radiofrequency ablation or surgery, the prognosis of such tachyarrhythmias remains serious.
Mechanisms of AV Node Modulation in AV Node Reentry Tachycardia
Authors: SCHLÄPFER JÜRG. , KAPPENBERGER LUKAS
Published: June 2007

Atrioventricular nodal reentrant tachycardia has been recognized for many years as a very common cause of supraventricular tachycardia. First curable by surgery, this tachycardia is now successfully approached by selective radiofrequency current application to the slow pathway of the reentrant circuit. Importantly, these curative treatments brought evidence that the reentrant circuit of this arrhythmia was not confined to the compact atrioventricular (AV) node. These findings stimulate anatomists and basic and clinical electrophysiologists to fundamentally reconsider the atrioventricular junction in order to better understand the mysteries of atrioventricular junctional reentrant tachycardia, as we still do not know exactly what we are doing in AV node region procedures. This article will focus on the different hypotheses regarding the effect of selective slow AV pathway ablation in AV junctional reentrant tachycardia.
Clinically Significant Nondominant Right Coronary Artery Disease
Authors: ZUBAID MOHAMMAD , LAW SAMIH R.
Published: June 2007

The literature is scarce regarding the management of ischemia due to disease of the nondominant right coronary artery (NDRCA). We describe two patients who suffered from myocardial ischemia due to significant disease of the NDRCA. Both were managed with balloon angioplasty. Disease of the NDRCA can be a source of ischemia and should be dealt with like other coronary vessels. (J Interven Cardiol 1996;9:59–64)
Recanalization of Chronically Occluded Coronary Arteries: Single‐Center Experience in 400 Cases, Including Long‐Term Angiographic Follow‐Up
Authors: HERRMANN GUNHILD , MUÚRLING STELLA , WILLE BERND , ZERBST JOACHIM , SIMON RÜDIGER
Published: June 2007

The study presented comprises the initial and angiographic long‐term results of a consecutive series of recanaliza‐tion procedures in a single center. Between 1988 and 1992, a total of 400 patients underwent transluminal recanalization for total coronary occlusions. In 82% of successfully attempted patients, the occlusion could be passed by a standard guidewire. The overall initial success rate was 75% (298 of 400). The highest success rates could be achieved in the left circumflex artery (84%) and left anterior descending coronary artery (77%). Complications were uncomplicated myocardial infarction in ten patients (2.5%) and death in two patients (0.5%). Angiographic follow‐up 3–6 months after recanalization could be achieved in 263 (88%) of 298 patients. Significant restenosis (≥ 50% minimum lumen diameter) was found in 57 (22%) of 263, and reocclusion was present in 38 (14%) of 263 patients, resulting in a total recurrence rate of 36%. In conclusion, recanalization can be performed with an initial success rate of 75% using bare‐wire technique under the prerequisite operator experience. If a nearly complete angiographic follow‐up is performed, the overall recurrence rate is 36%, which seems to be very acceptable in comparison with PTC A results for incomplete obstructions published so far. (J Interven Cardiol 1996;9:73–79)
Carotid Endarterectomy: When and in Whom?
Authors: JAFF MICHAEL R.
Published: June 2007

Carotid endarterectomy has been a widely used method of preventing primary or secondary cerebrovascular ischemic events since the 1950s. Over the past several years, the interest in this surgical procedure has increased due to the publication of several large randomized trials comparing best medical therapy (antithrombotic) with carotid endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has demonstrated a risk reduction of 65% in patients who underwent carotid endarterectomy for symptomatic carotid stenosis. The Asymptomatic Carotid Atherosclerosis Study (ACAS) also demonstrated a benefit of carotid endarterectomy, however, in a group of asymptomatic patients. There was an approximate reduction of 6% in stroke in patients undergoing carotid endarterectomy in this series. Carotid endarterectomy is the treatment of choice in patients with symptomatic extracranial carotid atherosclerosis. Data is now emerging that this is also an effective therapy in patients with asymptomatic carotid stenosis. The perioperative stroke risk by the surgeon performing the procedure and the patient's co‐morbid medical conditions are important factors to consider before proceeding with surgical treatment of this disorder.
Carotid Artery Stenting: A Vascular Surgeon‐Endovascular Specialist's Perspective
Authors: DIETHRICH EDWARD B.
Published: June 2007

Endovascular interventions were developed to provide minimally invasive alternatives to standard surgical therapies. Where an endoluminal technique has the potential to supplant its surgical predecessor, the rival must prove itself against the gold standard in terms of outcome, complications, and durability. In the case of carotid stenting, the stroke risk reduction data for carotid endarterectomy gathered from recent randomized trials appear to be unassailable. In the face of this challenge, why would we pursue an endoluminal alternative? Would the investment in resources and device development result in benefit to the patient? In this perspective, an endovascular surgeon proposes several possible case scenarios appropriate to carotid stenting and reviews progress to date on the investigation of this therapeutic alternative.
Economic and Ethical Considerations in Percutaneous Coronary Revascularization
Authors: HLATKY MARK A.
Published: June 2007

New devices for catheter‐based coronary revascularization provide substantial economic and ethical challenges. It is important for new technologies to undergo rigorous evaluation, and for the outcome assessment to include long‐term follow‐up. The outcome should include medical resource use and economic end points, as well as the traditional clinical measures, so that the cost‐effectiveness of new technology can be assessed. Society must strike a balance between uncontrolled proliferation of new technology and the stifling of innovation by restrictive regulatory and reimbursement policies. The clinical investigator and interventional cardiologist must be aware of the potential of new technology to pose ethical dilemmas, and establish checks and balances to protect against abuses.
Reliable Models of Severe Coronary Stenosis in Porcine Coronary Arteries: Lesion Induction by High Temperature or Copper Stent
Authors: STAAB MICHAEL E. , MEEKER DANIEL K. , EDWARDS WILLIAM D. , CAMRUD ALLAN R. , JORGENSON MICHAEL A. , CAMRUD LADONNA J. , SRIVATSA SANJAY S. , JEONG MYUNG HO. , GREGOIRE JEAN , HOLMES DAVID R. , SCHWARTZ ROBERT S.
Published: June 2007

Severe, chronic, and nonfatal stenoses in coronary arteries have been difficult to induce consistently in large animals. Availability of such a model would have practical applications, including understanding the pathophysiology of coronary stenoses and testing new interventional devices. Current methods of producing stenosis typically require an open chest preparation, are time‐consuming, and expensive. The purpose of this study was to report two reliable methods for creating severely stenotic lesions percutaneously in a porcine model without the need for an atherogenic diet. Two methods for producing severe coronary stenoses in pigs were found: (1) thermal balloon angioplasty at high temperature (80°C), and (2) implantation of elemental copper stents. Both were performed using a carotid artery cutdown. Pigs were euthanized, the hearts perfusion fixed, and arteries examined histologically. Thermal balloon angioplasty injury produced lesions with mean histopathological stenosis of 67%± 27% and mean angiographic stenosis of 70%± 21%. Histopathological examination showed medial necrosis, adventitial fibrosis, and occasional calcification of the external elastic lamina. Copper stent deployment created a mean histopathological stenosis of 81%± 22% and mean angiographic stenosis of 84%± 17%. Histopathological evaluation revealed inflammatory lesions with destruction of the elastic laminas and gross enlargement of vessel diameter. Two practical methods that reliably create severe coronary artery stenoses use intracoronary heat or copper stent implant. These lesions can be used for testing coronary interventional and diagnostic devices. These models generate lesions that form rapidly, use standard percutaneous techniques, and do not require intrathoracic surgery or atherogenic diets.
Single Coronary Artery
Authors: KIM NAM H. , TALLEY J. DAVID , JAVIER JULIAN J. , DINH HA
Published: June 2007

A 54‐year‐old postmenopausal female, with systemic arterial hypertension and insulin dependent diabetes mellitus, had exertional chest discomfort. At cardiac catheterization, a single coronary artery arising from the right sinus of Valsalva was seen (Fig. 1). This condition is extremely rare, discovered in < 0.05% of the general population. Transesophageal echocardiography using color flow imaging documented that the left anterior descending coronary artery was anterior to the pulmonary artery (Fig. 2).
Progress in Interventional Cardiology
Authors: Talley J. David , Waksman Ron
Published: June 2007

This issue of News & Views will review results of clinical trials presented immediately prior to and during the 69th Scientific Sessions of the American Heart Association meetings (November 10–13, 1996, New Orleans, LA, USA). Areas of focus include the importance of endothelial dysfunction in interventional cardiology, radiation used to treat restenosis following percutaneous coronary intervention, and new anti‐platelet agents used in preventing secondary events following the initial clinical manifestation of coronary artery disease.
The Feasibility of Systematic Use of a Combined Diagnostic and Interventional 6 Fr Guide Catheter in Patients with Suspected Coronary Restenosis
Authors: JUILLIÈRE YVES , DIBON OLIVIER , EDEL FRANÇOIS , BERDER VÉRONIQUE , CADOR ROMAIN , DANCHIN NICOLAS , CHERRIER FRANÇOIS
Published: June 2007

This prospective study assessed the feasibility of re‐percutaneous transluminal coronary angioplasty for coronary restenosis using routinely the new 6 Fr diagnostic/interventional Diaventional catheter with a large internal lumen (0.057) in 80 consecutive patients. Two patients had restenosis on two vessels. The restenosed coronary artery more frequently was the left anterior descending coronary artery (52%). In the first six patients, the over‐the‐wire technique was used; in the other patients, we used a balloon‐on‐a‐wire device or a rapid‐exchange balloon catheter. With these latter techniques, angiographic visualization was satisfactory, even when the balloon was placed through the stenosis. The balloon size varied from 2.0‐3.5 mm (mean 2.9 ± 0.4 mm). In two patients, an immediate recoil needed reintervention with the same equipment and yielded a satisfactory final result. All but one procedure (81/82) were successful (in one patient, a total chronic occlusion could only transiently be reopened). However, in four patients, a complementary 6 Fr or 8 Fr technique, using standard guiding catheters, had to be used for a large dissection (two patients) and for failure to cross a tight stenosis (two patients). The overall success rate was 94% (77/82), with a 9.2% reduction of the total cost of the invasive procedure. In coronary restenosis, the use of the new 6 Fr diagnostic/interventional Diaventional catheter is possible with an excellent overall success rate and a reduction of the total cost of the invasive procedure.
Cutting Balloon Angioplasty for a Restenosis Lesion at the Distal Anastomosis of a Saphenous Vein Graft
Authors: INOUE TERUO , HOSHI KAZUHIRO , MIZOGUCHI KEIICHI , SHIMIZU MINORU , SAKAI YOSHIHIKO , MOROOKA SHIGENORI
Published: June 2007

We successfully performed cutting balloon angioplasty for a restenotic lesion involving the distal saphenous vein graft (SVG) anastomosis that had developed within 1 month after conventional balloon angioplasty. We considered that cutting balloon angioplasty, which has been considered to produce less vascular injury, could be a viable choice for the treatment of a lesion at the distal anastomosis of an SVG.
Retraction of a Malfunctioning Cardiac Bioptome from the Heart
Authors: BAGGER JENS PEDER.
Published: June 2007

A cardiac bioptome with persistent open jaws due to malfunction was removed from the cardiac cavity after the bioptome covering had been peeled off and a fractured wire identified and manipulated.
Twister
Authors: JAVIER JULIAN J. , LIU JAMES H. , BISSETT JOE K. , TALLEY J. DAVID
Published: June 2007

A 75‐year‐old male presented with an extensive anterior myocardial infarction. He underwent primary coronary angioplasty to the proximal left anterior coronary artery, which was successful and uncomplicated. Several days later he sustained a cardiac arrest and was successfully resuscitated. An electrophysiological study revealed inducible ventricular tachycardia. An automatic implantable cardioverter defibrillator (ICD) was placed in a subcutaneous abdominal position. After the device was implanted, the patient developed pneumonia and a hematoma in the generator pocket.
Progress in Interventional Cardiology
Authors: Talley J. David , Conley Thomas D.
Published: June 2007

This issue of News & Views will focus on new developments in contrast media agents, low molecular weight heparin, and glycoprotein (GP) Hb/IIIa inhibitors used in the treatment of acute and chronic coronary artery disease, and optimal anticoagulation therapy after placement of an intracoronary stent.
Safety and Efficacy of Angiographic Guided Elective Palmaz‐Schatz Stent Implantation Without Coumadin: Comparison of Stent Implantation and Angioplasty
Authors: MIKETI SINIŠA , CARLSSON JOERG , TEBBE ULRICH
Published: June 2007

This study was designed to evaluate the safety and efficacy of routine high‐pressure Palmaz‐Schatz coronary stenting in patients with symptomatic coronary heart disease with only angiographic guidance without coumadin for poststenting treatment. Intracoronary stenting reduces restenosis rate after coronary angioplasty. High pressure stent deployment with intravascular ultrasound guidance reduces the incidence of stent thrombosis, despite reduction of anticoagulation. However, the feasibility of routine stent implantation with only angiographic guidance and without coumadin for poststenting treatment has not yet been determined. Patients undergoing coronary angioplasty for symptomatic coronary heart disease received stent implantation for abrupt or threatening vessel occlusion, vessel dissection without compromised antegrade blood flow (but at high risk for subacute occlusion and early restenosis), unsatisfactory angioplasty result with > 30% residual stenosis, and elective stent implantation in de novo lesions, restenotic lesions, and lesions in bypass grafts. Quantitative coronary analysis was performed before the procedure, immediately after, and at follow‐up 6 ± 1 (SD) months later. This patient group was matched for clinical and angiographic characteristics with those patients who underwent balloon angioplasty during the same period. Patients who underwent coronary stenting had larger net gain (1.95 ± 1.0 vs 1.42 ± 0.9; P < 0.001) resulting in a larger minimal luminal diameter (2.48 ± 1.19 vs 1.78 ± 1.01; P < 0.001) at follow‐up as compared with balloon angioplasty. Restenosis, defined as > 50% diameter stenosis at follow‐up, occurred in 35.0% in the PTCA group and in 16.1% in the stent group (P < 0.001). Subacute stent thrombosis occured in one patient (0.8%) due to angiographically evident suboptimal stent expansion. Routine coronary high pressure Palmaz‐Schatz stenting with angiographie guidance without coumadin for poststenting treatment represents a safe and effective option in patients with symptomatic coronary heart disease without increasing the incidence of (sub)acute stent thrombosis.
Multicenter Pilot Study of a Serpentine Balloon‐Expandable Stent (beStentTM): Acute Angiographic and Clinical Results
Authors: BEYAR RAFAEL , ROGUIN ARIEL , HAMBURGER JAAP , SAAIMAN ANDRE , BARTORELLI ANTONIO L. , DiMARIO CARLO , COLOMBO ANTONIO , M.D. CHRISTIAN W. HAMM , WHITE CHRISTOPHER J. , MARCO J. , SERRUYS PATRICK W.
Published: June 2007

The beStent is a new stainless steel, balloon‐expandable mesh stent which has a unique serpentine design. Rotation of the unique low stress junctions upon expansion leads to orthogonal locking of the wires, maximizing radial strength and assuring zero shortening. The stent has delineating gold markers which assure precise positioning. We aim to present the initial acute results in a pilot registry for stent evaluation. Two hundred eighty‐four stents were used in a total of 217 patients (age 57.9 ± 3.10 years; 178 males; 39 females) in seven centers, for variable indications. Stents of 15‐, 25‐, and 35‐mm length were used. The arteries treated were the left anterior descending (n = 112, 42%), circumflex (n = 54, 20.2%), right coronary (n = 95, 35.5%), left main (n = 1, 0.4%), and vein graft (n = 5, 1.9%). Lesion types were: A in 42 patients (16.5%); B1 in 53 patients (20.7%); B2 in 81 patients (31.8%); and C in 79 patients (31%). One hundred fifty‐nine patients required one stent, 40 patients required two stents, and 18 patients required three or more stents. Anticoagulation protocol included procedural heparin with aspirin with/without ticlopidine. Smooth angiographie results were obtained in all cases with no plaque herniation. Acute angiographic success was obtained in 97% of the patients, and acute clinical success in 95% of the patients. Complications within 30 days were: 3 deaths (1.4%) (2 noncardiac); 2 (0.9%) myocardial infarctions; and 2 (0.9%) stent thromboses. Therefore, the beStent is useful in treatment of complex lesions of variable length and complexity, providing excellent acute results with a low complication rate, in spite of unfavorable basic clinical and angiographie characteristics.
Long‐Term Restenosis After Multiple Stent Implantation: A Quantitative Angiographic Study
Authors: REIMERS BERNHARD , MARIO CARLO DI. , PASQUETTO GIAMPAOLO , BIRGELEN CLEMENS VON. , GIL ROBERT , VAN DEN BRAND MARCEL , VAN DER GIESSEN WIM , FOLEY DAVID , SERRUYS PATRICK W.
Published: June 2007

Elective high pressure stent implantation in focal coronary lesions has a high procedural success and low incidence of restenosis in comparison with balloon angioplasty. For the treatment of diffusely diseased coronary arteries, however, a high incidence of subacute thrombosis and late restenosis has been reported. The aim of this study was the prospective evaluation of procedural and long‐term outcome after implantation of multiple stents. In a consecutive series of 48 patients, 48 lesions were treated with the implantation of 120 stents (2.5 ± 1.0 stents/lesion). Stent implantation was performed electively in 15%, for dissection in 56%, and for suboptimal balloon angioplasty result in 29% of patients. The lesion length before stenting, including balloon angioplasty induced dissections, was 28.5 ± 9.8 mm (range 20–62), the mean length of the stented segment was 40 ± 16 mm. The procedure was successful in 45 patients (95%). Procedural related complications included two urgent bypass operations (4%) and one transmural myocardial infarction (2%). Two subacute stent thrombosis events (4%) occurred, both in‐hospital, 1 and 3 days after implantation. Follow‐up was obtained in 43 eligible patients at 6.4 ± 1.3 months, revealing an overall restenosis rate of 30% (13 patients). Quantitative angiography (CAAS II, edge detection algorithm) showed a minimal lumen diameter of 0.93 ± 0.28 mm (diameter stenosis 62%± 13%) before treatment, 2.81 ± 0.26 mm (diameter stenosis –4 ± 13%) after stenting, and 1.79 ± 0.58 mm (diameter stenosis 30%± 20%) at follow‐up. Predictors of restenosis were not identified. Thus, multiple stent implantation has high procedural success and the late restenosis of long lesions after multiple stents compares favorably with balloon angioplasty.
Prehospital Thrombolysis in Acute Myocardial Infarction Salvages Myocardium
Authors: GOTSMAN MERVYN S. , WEISS A. TEDDY , ROZENMAN YOSEPH , LOTAN CHAIM , ZAHGER DORON , MOSSERI MORRIS
Published: June 2007

Early thrombolysis can be given at home, by a medical intensive care unit ambulance team, in the emergency room, or in the coronary care unit. Thrombolysis should be given very early (<2 or 4 hours) and reestablish normal or near normal coronary blood flow. Methods of management include home monitoring of high risk patients with a transtelephonic 12‐lead monitor ECG, the management of the patient at home by a trained GP, physician, or medical technician controlled intensive care ambulance team, or a rapid “door to needle” time in the emergency room. Each of these systems requires patient and physician reeducation, to make each group aware of the advantages of early and complete revascularization. An alternative fast track can be provided by immediate percutaneous transluminal coronary angioplasty if the hospital can be prewarned by the physician outside. This article reviews the current published literature and also our experience in 760 patients in Jerusalem. Infarct size, complication rate, and long‐term prognosis is related to early complete restoration of coronary blood flow.
Advances in Antiplatelet Therapy in Coronary Artery Disease: Importance of the Platelet GPIIb/IIIa Receptor
Authors: TIMMIS GERALD C. , KHURANA SANDEEP
Published: June 2007

It is now widely agreed that platelets are intimately involved in and contribute to the pathogenesis of acute coronary thrombosis. Aspirin, a relatively weak inhibitor of platelet activation, saves lives when administered early after acute myocardial infarction and should be routinely used as lifelong therapy in patients with coronary atherosclerosis. Ticlopidine has a mechanism of action distinct from and additive to that of aspirin; it inhibits activation of platelets mediated by the agonist, adenosine diphosphate (ADP). The reduction in subacute coronary thrombosis attained by the use of combination therapy with aspirin and ticlopidine (for 2–4 weeks) after intracoronary stenting is further evidence of the role of platelets in mediating acute arterial thrombosis. Potent platelet agonists (like thrombin) can override the effect of aspirin and ticlopidine; therefore these agents are of limited efficacy. In contrast, inhibitors of the platelet glycoprotein (GP) IIb/IIIa receptor are potentially more potent inhibitors of adhesive platelet interaction and may therefore be effective in blocking adhesive platelet interactions irrespective of the activating agonist. The GPIIb/IIIa receptor mediates the bridging of platelets (platelet aggregation) via fibrinogen, thus allowing platelet to bind other platelets at the injured vessel wall. Antagonists of this receptor are thus capable of blocking the “effector function” by acting at a step that is downstream to platelet activation. By abrogating the final common pathway of platelet aggregation, antagonists of GPIIb/IIIa also affect the most proximal step in thrombin generation (that most efficiently occurs on the membrane surface provided by platelets). Accordingly, these agents can profoundly inhibit arterial thrombosis. The clinical use of the antibody fragment directed against the GPIIb/IIIa receptor (c7E3 Fab) has truly revolutionized the practice of interventional cardiology and has the potential to effectively treat heparin‐resistant intracoronary thrombosis. Synthetic antagonists of fibrinogen binding to the GPIIb/IIIa receptor (the “fibans”) are currently under initial clinical testing.
Intimal Cell Density in Postangioplasty Versus Primary Coronary and Peripheral Lesions: A Systematic Study on Human Atherectomy Samples
Authors: BAURIEDEL GERHARD , SCHMÜCKING INGO , SCHMIDT THOMAS , BRAUN PETER , PARK JAI‐WUN , HEINRICH KARL‐WILHELM , LÜDERITZ BERNDT
Published: June 2007

Our knowledge of the identity and functional significance of the pathogenic mechanisms responsible for restenosis and arteriosclerosis in man is still limited. Among others, phenotypic conversion, migration, and proliferation of smooth muscle cells have been suggested to lead to hypercellular neointima. In the present study, we examined intimal cell numbers and cell types in tissue of 23 postangioplasty lesions biopsied by directional atherectomy. using histology and transmission electron microscopy. Comparative tissue analysis was performed for 53 primary lesions. Tissue specimens obtained from coronary (n = 32) and peripheral lesions (n = 44) of 69 symptomatic patients were analyzed. Histological assessment of cell density showed intra‐ and interlesional variability. A markedly (P < 0.001) higher cellularity was found in postangioplasty compared to primary lesions, irrespective of coronary or peripheral origin. Cell density in renarrowed tissue following angioplasty (2 to 30 months) did not significantly decrease regardless of previous balloon dilatation or atherectomy. When categorizing intimal cell density, postangioplasty lesion hypercellularity (75th percentile; > 514 cells/mm2) was observed in 12/23 lesions (52%), but hypocellularity (25th percentile; < 76 cells/mm2) in none. In contrast, primary lesions were more variable, with hypercellularity in 7/53 plaques (13%), and hypocellularity in 19/53 (36%). Transmission electron microscopic analysis of subcellular features revealed hypocellular plaques to have an extensive build‐up of extracellular matrix, with only sparsely embedded smooth muscle cells (SMCs). These SMCs have a range of intermediate to microfilament‐rich contractile phenotypes, thereby indicating only marginal metabolic activity. In contrast, hypercellular plaque regions contained predominantly organelle‐filled SMCs, irrespective of postangioplasty or primary origin. In conclusion, increased SMC density was observed predominantly in most renarrowed lesions encompassing classical restenoses (2 to 6 months post angioplasty) as well as late recurrent lesions (7 to 30 months postangioplasty). Concordantly, primary lesion hypercellularity is suggested to be related to the formation and progression of native arteriosclerosis.
Diabetes Mellitus as a Risk Factor for Development of Vulnerable (Unstable) Coronary Plaque: A Review of Possible Mechanisms
Authors: SILVA JOSE A. , WHITE CHRISTOPHER J.
Published: June 2007

The prevalence of early and severe atherosclerotic coronary disease is much higher in diabetic patients than in their nondiabetic counterparts. The incidence of acute coronary syndrome is also disproportionately higher in this population. This difference has generally been attributed to a much higher prevalence of traditional risk factors such as hypertension and dyslipidemias in diabetic patients; however, a clear explanation is yet to be found. Vascular injury and growth factors are increased in these individuals. Metabolic and biochemical abnormalities such as glycosylation and oxidation of low density lipoprotein (LDL) and the formation of “large” very low density lipoprotein (VLDL) promote the accumulation of monocytes and macrophages, leading to the formation of foam cells. Glycosylation of high density lipoprotein (HDL) impairs its antiatherogenic action. These abnormalities may enhance the extracellular (core) lipid content of the atherosclerotic plaque, rendering it softer. An augmented inflammatory response also appears to take place in the atherosclerotic plaque of diabetic patients. There is a strong chemotaxis for monocytes and macrophages mediated by glycoxidation. These cells induce the secretion of interleukin‐1 and cachectin/tumor necrosis factor, which in turn inhibit nitric oxide activity, leading to detrimental action of mast cells. Diabetic patients also have an enhanced vasoconstrictive response. Significant platelet, coagulation, and fibrinolytic abnormalities are also present in these individuals, which favor a relatively hypercoagulable state. Plaque stress due to enhanced tensile and compression forces appears to be increased in diabetic patients.
Six‐month Follow‐up of Successful Stenting for Acute Dissection After Coronary Angioplasty: Comparison Between Slotted Tube (Palmaz‐Schatz) and Flexible Coil (Gianturco‐Roubin) Stent Designs
Authors: FERNÁNDEZ‐ORTIZ ANTONIO , GOICOLEA JAVIER , PÉREZ‐VIZCAYNO MARÍA J. , HERNÁNDEZ ROSANA , ALFONSO FERNANDO , SEGOVIA JAVIER , BAÑUELOS CAMINO , MACAYA CARLOS
Published: June 2007

The aim of this study was to evaluate the influence that two different stent designs may have in late outcome following successful coronary stent implantation for acute dissection after balloon angioplasty. In the present study, 50 consecutive patients were matched to compare late outcome between the use of slotted tube (Palmaz‐Schatz) and flexible coil (Gianturco‐Roubin) stent designs (25 in each group). Group matching was performed according to vessel size, location of target lesion, and dissection type among patients undergoing successful coronary stenting to treat an acute dissection following balloon coronary angioplasty. Poststent minimal luminal diameter (2.46 ± 0.49 mm vs 2.35 ± 0.47 mm, not significant [NS]) and acute luminal gain (2.02 ± 0.61 mm vs 1.85 ± 0.56 mm, NS) were similar in slotted tube and flexible coil stent groups, respectively. However, at 6‐month follow‐up, late loss in luminal diameter was larger in lesions treated with a flexible coil stent (0.96 ± 0.75 mm vs 0.62 ± 0.55 mm, P = 0.05), and minimal luminal diameter was smaller in those lesions treated with a flexible coil stent (1.38 ± 0.87 mm vs 1.84 ± 0.63 mm, P < 0.05). Angiographic restenosis (> 50% diameter narrowing) occured in four lesions treated with a slotted tube stent (16%) compared to ten lesions treated with a flexible coil stent (40%, P < 0.05). The design of the coronary stent may have significant influence in the late lesion outcome. In patients with acute dissection following balloon coronary angioplasty, use of a slotted tube stent design (Palmaz‐Schatz) may result in lower late loss and larger luminal diameter at 6‐month follow‐up than use of a flexible coil stent design (Gianturco‐Roubin).
Protected Left Main Angioplasty: Alterations of Intracoronary Doppler Flow Velocity
Authors: CRAIG WILLIAM R. , CARACCIOLO EUGENE A. , KERN MORTON J.
Published: June 2007

Coronary blood flow velocity measurements during protected left main coronary angioplasty have not been previously reported. In a patient undergoing angioplasty of left main and circumflex vessels with prior coronary artery bypass grafting, distal coronary flow velocity was measured before, during, and after angioplasty, and again after stenting of the circumflex stenosis. The data demonstrated preserved coronary flow during left main occlusion in this individual and provided new observations that highlight the limitations of our understanding of myocardial blood flow in complex circumstances of high risk angioplasty and interventions following bypass graft surgery.