bluuebunny/crossref_metadata_2025 huggingface dataset:
Melanoma vaccine candidates from chimeric hepatitis B core virus‐like particles carrying a tumor‐associated MAGE‐3 epitope
Authors: Kazaks Andris , Balmaks Reinis , Voronkova Tatyana , Ose Velta , Pumpens Paul
Published: October 2008

Vaccination of melanoma patients with tumor‐specific antigens recognized by cytotoxic T lymphocytes (CTLs) may produce significant tumor regressions. Here, we suggest a novel type of tumor vaccines, with well‐studied CTL epitopes presented on highly immunogenic virus‐like particle (VLP) carriers. Cancer‐germline gene MAGE‐3 encodes for an antigenic nonapeptide (MAGE‐3168–176 peptide) that is recognized by CTLs on human leukocyte antigen (HLA)‐A1 and HLA‐B35 molecules. A set of recombinant genes encoding hepatitis B virus core protein carrying MAGE‐3 epitope was constructed and expressed in Escherichia coli cells. Variants that led to formation of chimeric VLPs in vivo were purified and analyzed for their DNA binding properties in vitro. VLPs exhibiting the most pronounced nucleic acid binding affinity were selected and loaded either with single‐stranded DNA oligodeoxynucleotides rich in nonmethylated CG motifs, or with longer double‐stranded DNA fragments. Packaged DNA was protected, at least partially, against the action of bacterial DNase. Such highly purified chimeric VLPs with entrapped immunomodulatory sequences could possibly be used as antitumor vaccines.
RIC‐3 and nicotinic acetylcholine receptors: Biogenesis, properties, and diversity
Authors: Treinin Millet
Published: October 2008

Nicotinic acetylcholine receptors (nAChRs) belong to a diverse and widely expressed family of ion channels. These receptors are pentamers assembled from multiple combinations of subunits, with different subunit compositions producing receptors having different properties and functions. The diverse functions of nAChRs include an essential role in excitation of skeletal muscles and many modulatory roles throughout the central nervous system. Nicotinic receptors are also implicated in a number of brain pathologies such as epilepsy, schizophrenia, and Alzheimer's disease. Thus, it is important to understand the cellular mechanisms controlling both the numbers and the properties of surface expressed nAChRs. Genetic analysis in Caenorhabditis elegans identified a number of proteins specifically needed for biogenesis of nAChRs. Among these proteins is RIC‐3, a member of a family of proteins having conserved structure and function. RIC‐3 influences both surface expression and properties of nAChRs and its effects are subtype specific. Here we suggest that receptor‐specific chaperones such as RIC‐3 may play important roles in controlling receptor diversity by selectively regulating surface expression of nAChRs having specific subunit compositions.
Exploring Chinese consumer repurchasing intention for services: An empirical investigation
Authors: Dongjin LI , Shenghui AN , Kai YANG
Published: October 2008

With the increasingly tough competition, companies are trying to keep existing customers as well as expand the market base in China, which implies that understanding the Chinese consumer repurchasing intention has become one of the important issues. Consumer repurchase intention is an important indicator to predict repurchase behavior. The aim of this paper is to understand the factors that influence consumer repurchase intention in China. Specifically, this paper explores the relationship between perceived values, customer satisfaction, switching costs, purchase interval, and repurchase intention in China with Structural Equation Modeling. The empirical study finds that perceived value, customer satisfaction, and switching costs are positively related to the repurchase intention while purchase interval does not have significant influence on the repurchase intention. In addition, the perceived value is positively related to the customer satisfaction and there is no significant relationship between switching costs and customer satisfaction.

Copyright © 2008 John Wiley & Sons, Ltd.
Controversial product advertising in China: perceptions of three generational cohorts
Authors: Fam Kim‐Shyan , Waller David S. , Ong Fon‐Sim , Yang Zhilin
Published: October 2008

China is a country that has undergone a wide range of significant changes over the last 30 years, economically, politically, and socially. Major events not only have an important effect on the developmental history of a country such as China, but also create a new generational cohort, which can adopt different views and attitudes than those characterizing previous generations. This study analyses the results of a survey of three different generational groups in China, focusing on their attitudes towards the promotion of controversial products and advertising execution techniques. Research results show significant differences between the younger and older generations, especially in regard to gender‐related products and certain advertising execution techniques.

Copyright © 2008 John Wiley & Sons, Ltd.
On the malleable nature of product meaning in China
Authors: Eckhardt Giana M. , Houston Michael J.
Published: October 2008

While we know that consumers can hold varying meanings for products depending on context, the source of the variation is not clear. We investigate the source of malleable meanings in the Chinese context, as Chinese consumers are especially likely to hold multiple meanings for the same product. We discover that meanings can be inherently malleable, as opposed to one “true” meaning being altered by situational variables, and that the overwhelming importance of interpersonal relationships and the cultural categories that become salient in varying contexts are what allows incongruent meanings to be held non‐problematically in the Chinese context. This suggests that in China, marketing communications can be difficult to craft because consumer interpretations will be contextually driven, and that social relationships should be emphasized.

Copyright © 2008 John Wiley & Sons, Ltd.
Saving “face” in China: modernization, parental pressure, and plastic surgery
Authors: Lindridge Andrew M. , Wang Congying
Published: October 2008

Using adolescent women living and working in Shanghai, as our sample group, we argue that a consequence of a modernizing Peoples Republic of China1

Hence forth called China.

are the cultural values embodied in consumption are increasingly representing western consumption narratives. The extreme of this ideal is the consumption of the body through plastic surgery and the construction of an identity reflective of wider societal changes in China. Using an ethno‐consumerist methodology and interviewing women in Shanghai, our findings indicated that participants were encouraged to undertake plastic surgery operations by drawing upon traditional Chinese cultural hierarchies, i.e., family and society, and a need to compete in a modernizing society. Plastic surgery was used by participants then to construct a future biography of themselves as the embodiment of a new China: perfect, successful, and wealthy.

Copyright © 2008 John Wiley & Sons, Ltd.
Inhibitory effect of mesenchymal stem cells on lymphocyte proliferation
Authors: Gao Kun , Chen Younan , Wei Lingling , Li Shengfu , Jin Xi , Cong Cong , Yuan Yu , Long Dan , Li Youping , Cheng Jingqiu , Lu Yanrong
Published: October 2008

We investigated the mechanism underlying the inhibitory effect of rat mesenchymal stem cells (MSCs) on non‐specific mitogen‐stimulated lymphocytes (LCs) and lymphoblasts (LBs). We used MSCs of passages 2–8 prepared from Sprague–Dawley (SD) rats. LCs were isolated from the spleens of SD rats. Mixed LCs reactions of mitomycin C‐treated MSCs with concanavalin A (ConA)‐stimulated LCs or LBs were performed, and the proliferation inhibition effect was tested by MTS assay. The cytotoxicity of MSCs against naïve and ConA‐stimulated LBs was detected, after co‐culturing for 24 h, by lactate dehydrogenase release assay. The rate of apoptosis of ConA‐stimulated LBs was measured by flow cytometry after incubation with MSCs for 9 h in the ratio 10:1. The MSCs were treated with Fas ligand (FasL), transforming growth factor (TGF)‐β, and interleukin (IL)‐10 blocking antibodies and co‐cultured with ConA‐stimulated LBs to observe the apoptosis and growth inhibitory effect. The main outcomes were bone marrow‐derived adherent CD29+, CD44+, CD45−, CD54+, CD95+, and SH‐2+ MSCs. FasL, TGF‐β, and IL‐10 production by MSCs were visualized by immunocytochemical analysis. MSCs exhibited a dose‐dependent growth inhibitory effect on ConA‐stimulated LCs and LBs. When treated with anti‐FasL and anti‐IL‐10 blocking antibodies, the inhibitory effect of MSCs on LBs proliferation, and the effect of apoptosis induction on LBs decreased. Anti‐TGF‐β blocking antibody treatment did not significantly influence MSCs. Therefore, the inhibitory effects of MSCs against activated LBs were significantly stronger than that against naïve LCs. FasL and IL‐10, rather than TGF‐β, play important roles in the immunosuppressive effects of MSCs. Copyright © 2008 John Wiley & Sons, Ltd.
Transcatheter occlusion of a classical BT shunt with the Amplatzer Duct Occluder II
Authors: Kenny Damien , Walsh Kevin P.
Published: October 2008

We report on a 57‐year‐old woman who underwent transcatheter occlusion of a residual classical Blalock‐Taussig shunt with the Amplatzer® Duct Occluder II (ADO II) 35 years following definitive surgical correction for tetralogy of Fallot. © 2008 Wiley‐Liss, Inc.
Retrograde chronic total occlusion intervention: Tips and tricks
Authors: Wu Eugene B. , Chan Wilson W.M. , Yu Cheuk Man
Published: October 2008

Retrograde approach via collateral channels in coronary angioplasty for chronic total occlusion (CTO) can improve the success rate. Most interventionists will meet a few cases where the retrograde approach will provide unequaled advantages, but many are held back from taking retrograde approach by lack of proper equipment and expertise. In this article, we give detail description of techniques to shorten the guiding catheter, to traverse the collateral channels, and to cross the CTO. We also illustrate the difficulties in collateral channel crossing with different examples providing a basic guide for case selection purposes. We hope that many others would find rewardingly successful cases of retrograde approach CTO percutaneous coronary intervention, as in our experience. © 2008 Wiley‐Liss, Inc.
Carotid endarterectomy with simultaneous retrograde common carotid artery stenting: Technical Considerations
Authors: Bazan Hernan A. , Sheahan Malachi , Dardik Alan
Published: October 2008

Carotid endarterectomy with simultaneous retrograde common carotid artery stenting (CEA‐RCCAS) is performed with increasing frequency to treat tandem common and internal carotid artery stenoses. Technical details are not clearly delineated in the literature. Our procedure aims to maximize procedural ease and cerebral protection. Although the need for the endovascular component being performed first, followed by shunt placement, and the use of short wires and sheaths has been advocated, we describe the avoidance of shunt placement and the use of long sheaths to facilitate the procedure using local anesthesia and cervical blockade. Use of local anesthesia, avoidance of a shunt, and use of a long sheath may increase the procedural applicability and safety in some patients. CEA‐RCCAS permits safe simultaneous treatment of tandem common and internal carotid artery stenoses. The use of technical adjuncts described here will permit further expansion of the procedure to allow additional patients to be treated in this hybrid fashion. © 2008 Wiley‐Liss, Inc.
Is there a preferable DES in diabetic patients? A critical appraisal of the evidence
Authors: Byrne Robert A. , Kastrati Adnan
Published: October 2008

Drug‐eluting stent (DES) therapy reduces restenosis in patients with diabetes when compared with bare metal stent implantation. There are significant differences between commercially available DES platforms both in terms of design characteristics and clinical outcomes. Randomized active‐comparator inter‐DES trials powered for clinical endpoints are unlikely to be performed in patients with diabetes, however, direct comparison randomized trials utilizing surrogate endpoints support a superior anti‐restenotic efficacy with sirolimus‐ versus paclitaxel‐eluting stents. Thrombotic stent occlusion may be higher in patients with diabetes compared with nondiabetic patients, though there is no clear signal of a safety differential between the two platforms. Insufficient data on comparative performance in diabetics exist in relation to the approved zotarolimus‐eluting and everolimus‐eluting stent platforms. If all other factors are equal, then there seems to be no reason why the diabetic patient should not receive treatment with the sirolimus‐eluting stent, which appears to have superior antirestenotic efficacy in this patient group. © 2008 Wiley‐Liss, Inc.
Stent fractures in congenital heart disease
Authors: Breinholt John P. , Nugent Alan W. , Law Mark A. , Justino Henri , Mullins Charles E. , Ing Frank F.
Published: October 2008

Objective:

To describe incidence, characteristics, predictive factors, and sequelae of stent fractures in congenital heart disease.

Background:

Stent fracture in congenital heart disease patients is rarely reported.

Methods:

Patients with stents implanted from 1990 to 2006, with subsequent fluoroscopy were enrolled. Information obtained included: stent type, location, balloon diameter, and residual narrowing. Fracture characteristics, radiographic appearance, and clinical sequelae were also obtained in those with fractures identified.

Results:

Two hundred and sixty‐five patients (583 stents) had fluoroscopy 4.2 ± 3.3 years after stent implantation. The majority of stents (395, 67.7%) were placed in a pulmonary artery (PA) or its branches. Sixteen stents (2.7%) were placed in a right ventricle to pulmonary artery (RV‐PA) conduit. Fourteen fractures (2.4%) were identified 5.0 ± 3.2 years after implantation: RV‐PA conduit 4/16, proximal right PA 4/135, proximal left PA 6/184 (P = 0.003). Identification was primarily made on lateral fluoroscopy. Review of chest radiographs demonstrated fractures in only 71%. In fractured PA stents, five were redilated and three had additional stents placed. Of the four conduit stent fractures: one underwent redilation, one had embolized segments, and one was reinforced with a second stent that also fractured and embolized a segment during redilation at a later catheterization. All fractures were asymptomatic.

Conclusions:

With the exception of RV‐PA conduit stents, fracture is rare and asymptomatic. PA stent fractures occurred in 2.5% and did not embolize, whereas RV‐PA conduit stent fractures were significantly more common and may embolize. © 2008 Wiley‐Liss, Inc.
A novel technique using a steerable guide catheter to successfully deliver an Amplatzer septal occluder to close an atrial septal defect
Authors: Nounou Majed , Harrison Alex , Kern Morton
Published: October 2008

Correct positioning of an Amplatzer ASD occluder can be difficult in vertical hearts or in those with diminutive or missing septal rims. In this report we describe the use of a steerable sheath to position the device in the plane of the ASD to achieve success. © 2008 Wiley‐Liss, Inc.
Transcatheter occlusion of antegrade pulmonary flow in children after cavopulmonary anastomosis
Authors: Torres Alejandro , Gray Robert , Pass Robert H.
Published: October 2008

Objective:

To report our experience with transcatheter occlusion of antegrade pulmonary blood flow (APF) for postoperative complications of cavopulmonary anastomosis (BCPA).

Background:

It has been suggested that limited APF enhances pulmonary arterial growth in patients undergoing BCPA. However, APF may result in suboptimal postoperative hemodynamics and sequelae such as SVC syndrome or prolonged chest tube drainage. For this subgroup, closure of APF may alleviate these problems.

Methods:

All BCPA procedures where APF was left open from 1995–2005 were reviewed. Symptomatic patients with APF who underwent a cardiac catheterization in the postoperative period comprised the study cohort.

Results:

179 BCPA procedures were performed during the study period. APF was left patent in 29/179. 6/29 patients (age 10–28 months, median 14 months) presented 12 to 130 day; (median 31 days) with persistent pleural effusions (5) or SVC syndrome (1, Five had a history of a previous pulmonary arterial band (PAB) and one pulmonary stenosis. PA pressure was elevated in all (range 17–27 mmHg; median 22 mmHg). Hemodynamic evaluation with temporary APF occlusion was repeated in all patients. APF was successfully closed in 4/6 patients. The Amplatzer POA occluder was used in 3 and the Amplatzer ASD occluder in 1. Pulmonary effusions resolved in all the patients who had transcatheter APF closure as did the case of SVC syndrome. There were no complications.

Conclusion:

Transcatheter APF occlusion seems both safe and feasible in patients with hemodynamic compromise following BCPA with residual APF. Temporary occlusion testing prior to permanent device closure is recommended. © 2008 Wiley‐Liss, Inc.
Multiple stent fractures at the site of coronary artery bypass insertion
Authors: Hetterich Holger , Rieber Johannes
Published: October 2008

Drug eluting stents have led to a substantial reduction of in‐stent restenosis. Stent fracture (SF) is an important cause for the cases of restenosis which still occur. Sites of increased vessel movement, long stents, and overlapping stents have been observed to be more prone to fracture. We report the case of a patient with multiple drug eluting SFs at the site of coronary artery bypass insertion. The decision to implant stents at the site of bypass insertion should be made carefully. SF should be considered when gaps between previously implanted stents are observed. © 2008 Wiley‐Liss, Inc.
Electrosurgical energy in combination with a transseptal needle: A novel method for the creation of an atrial communication in hypoplastic left heart syndrome with intact atrial septum
Authors: Gordon Brent M. , Levi Daniel S. , Shannon Kevin M.
Published: October 2008

Neonates with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) usually present with severe acidosis and hypoxemia that necessitate immediate intervention to create an atrial septal defect (ASD). Transcatheter creation of an ASD in these patients requires transseptal puncture of a thickened atrial septum in the setting of a very small left atrium. We report on a novel method of perforating the atrial septum using radio‐frequency energy in combination with a transseptal needle to facilitate transseptal puncture and subsequent stent placement in a very thick atrial septum of a newborn with HLHS/IAS and a small left atrium. © 2008 Wiley‐Liss, Inc.
PCI versus CABG for multivessel coronary disease in diabetics
Authors: Tarantini Giuseppe , Ramondo Angelo , Napodano Massimo , Favaretto Enrico , Gardin Arianna , Bilato Claudio , Nesseris Georghios , Tarzia Vincenzo , Cademartiri Filippo , Gerosa Gino , Iliceto Sabino
Published: October 2008

Objectives: To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug‐eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment. Background: Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES‐PCI versus CABG in DM patients with MVD. Methods: From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES‐PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke. Results: Compared with PCI patients, CABG patients had higher prevalence of 3‐vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2‐year follow‐up, MACCE were not different between CABG group and DES‐PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES‐PCI increased the risk of 24‐month MACCE in total population (OR 1.8; P = 0.04). Conclusions: For patients with DM and MVD, a clinical judgment‐based revascularization by DES‐PCI is not associated with worse 2‐year outcome compared with CABG. © 2008 Wiley‐Liss, Inc.
Percutaneous coronary intervention in anticoagulated patients via radial artery access
Authors: Helft Gérard , Dambrin Grégoire , Zaman Azfar , Le Feuvre Claude , Barthélémy Olivier , Beygui Farzin , Favereau Xavier , Metzger Jean‐Philippe
Published: October 2008

Objectives: To assess safety and feasibility of using radial artery access for percutaneous coronary intervention (PCI) in patients on oral anticoagulation without interrupting therapy. Background: The radial artery approach for PCI is intuitively attractive for patients receiving chronic oral anticoagulation with vitamin K antagonists (VKAs) but little data exist concerning feasibility or safety of this approach in this population. The main advantage of this strategy would be to avoid bridging therapy with heparin that increases risk of thrombotic and bleeding events. Methods: In this prospective observational study, 50 consecutive patients referred for coronary angiography underwent PCI without interrupting oral anticoagulant therapy. The main outcome measures were bleeding and thrombotic complications. Results: The indications for permanent oral anticoagulation were as follows: atrial fibrillation in 62%, mechanical prosthesis in 24%, and venous thromboembolism in 14%. Seventy‐two percent were elective cases and 28% presented with acute coronary syndromes. PCI was performed with an INR range of 1.4–3.4 with mean of 2.2 ± 0.6. Seventy‐six percent of the patients were on dual antiplatelet therapy before the procedure. No thrombotic events or excess bleeding were observed at 1 month. Only one patient had a minor hemorrhage 8 days after procedure. Conclusions: This series suggests that for patients treated with VKAs, the use of radial artery access is feasible and safe for PCI on dual antiplatelet therapy without interrupting oral anticoagulant treatment. © 2008 Wiley‐Liss, Inc.
A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension
Authors: Troost Els , Delcroix Marion , Gewillig Marc , Van Deyk Kristien , Budts Werner
Published: October 2008

Aims: A significant number of patients with pulmonary hypertension are resistant to medical therapy. We wanted to evaluate whether the modified technique of stent fenestration of the interatrial septum would be feasible and safe, and offer clinical benefit. Methods and Results: The medical records of all patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension who underwent a stent fenestration of the interatrial septum between 2001 and 2008 were reviewed. In all fifteen patients (12 female, mean age 48.2 ± 20.5 years) a successful fenestration procedure could be performed. Median follow‐up time between diagnosis and fenestration was 2.3 years (range from 0.5 to 18.6 years). Mean event free survival since diagnosis and after septostomy was 9.8 ± 2.9 and 3.2 ± 0.8 years, respectively. When one extreme outlier was excluded, the 6 min walk distance improved significantly from 309 ± 69 m immediately before fenestration to 374 ± 84 m, 3–4 months after fenestration (n = 8, paired t‐test, P = 0.03). No stent occlusion occurred. Conclusion: The modified stent fenestration technique is feasible and safe in patients with severe pulmonary hypertension. In a selected group of patients, functional capacity might improve although disease progression continues. © 2008 Wiley‐Liss, Inc.
Persistent venous valves correlate with increased shunt and multiple preceding cryptogenic embolic events in patients with patent foramen ovale: An intracardiac echocardiographic study
Authors: Rigatelli Gianluca , Dell'Avvocata Fabio , Braggion Gabriele , Giordan Massimo , Chinaglia Mauro , Cardaioli Paolo
Published: October 2008

Background:

It has been suggested that prominent Eustachian valve (EV) and Chiari's network (CN) predispose to paradoxical embolism but their presence in patients with presumed paradoxical stroke is not always easily detectable by transesophageal echocardiography (TEE). We sought to prospectively assess the frequency of EV/CN as assessed by intracardiac echocardiography (ICE) in patients submitted to patent foramen ovale (PFO) transcatheter closure in order to investigate their role in determining shunt severity and risk of multiple paradoxical embolisms.

Methods:

Over a 36‐month period, we prospectively enrolled 98 consecutive patients (mean age 37 ± 12.5 years, 68 females) with previous stroke referred to our center for PFO catheter‐based closure. All patients underwent transcranial Doppler ultrasound (TC‐D), TEE and ICE‐guided transcatheter closure.

Results:

After ICE study and measurements, a prominent EV or CN were diagnosed on ICE in 72 patients (73.4%), whereas in 45 (45.9%, P < 0.01) on TEE. Patients with EV/CN had more frequently a curtain pattern on TC‐D, a larger right‐to‐left shunt, and recurrent cerebral paradoxical embolisms before closure. EV/CN and medium‐large shunt on TEE were the strongest predictors of recurrent paradoxical embolisms.

Conclusions:

This study suggests that EV and CN have a deep impact on the pathophysiology of paradoxical embolism: EV and CN should be considered as adjunctive risk factors for paradoxical embolism in the decision‐making process involving PFO patients. © 2008 Wiley‐Liss, Inc.
Stenting of a stenosed major aortopulmonary collateral artery in a baby with pulmonary atresia and a ventricular septal defect: Rescue from critical hypoxia in the immediate postoperative stage of unifocalization supported by extracorporeal membrane oxygenation
Authors: Tomita Hideshi , Matsuoka Takashi , Uemura Shigeru
Published: October 2008

A 4‐month baby with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries (MAPCAs) and an extremely hypoplastic central pulmonary artery developed critical hypoxia following right unifocalization combined with a right Blalock‐Taussig shunt. To increase pulmonary blood flow we stented the left lower MAPCA during extracorporeal membrane oxygenation (ECMO) support. He was successfully weaned from ECMO 2 days after stenting. Percutaneous intervention for a stenosed MAPCA is an effective means of increasing pulmonary blood flow in critically hypoxic patients following unilateral unifocalization, even in the immediate postoperative stage. © 2008 Wiley‐Liss, Inc.
External‐to‐internal iliac artery endografting for the exclusion of iliac artery aneurysms: An alternative technique for preservation of pelvic flow?
Authors: van Groenendael Laura , Zeebregts Clark J. , Verhoeven Eric L.G. , van Sterkenburg Steven M.M. , Reijnen Michel M.P.J.
Published: October 2008

Purpose:

The purpose of this study was to describe an alternative endovascular procedure to exclude iliac artery aneurysms, preserving perfusion to the internal iliac artery.

Cases:

Two patients, considered unfit for open repair, underwent endovascular repair of iliac artery aneurysms. One of these occurred after previous placement of a bifurcated prosthesis. In both cases the aneurysms were excluded using a nitinol stent covered with expanded polytetrafluoroethylene from the external to the internal iliac artery. Using this technique, the internal iliac arteries were perfused in a retrograde manner. Both interventions were technically successful. The external‐to‐internal endograft remained patent after 6 and 16 months, respectively.

Conclusion:

Endovascular placement of a stent‐graft from the external iliac artery into the internal iliac artery may offer an alternative and minimal invasive alternative for the management of common and internal iliac artery aneurysms. With the use of this technique, pelvic perfusion is preserved. Further studies are warranted to appraise the advantages and risk of this approach for iliac artery aneurysms. © 2009 Wiley‐Liss, Inc.
Impact of anticoagulation regimens on sheath management and bleeding in patients undergoing elective percutaneous coronary intervention in the STEEPLE trial
Authors: Gallo Richard , Steinhubl Steven R. , White Harvey D. , Montalescot Gilles ,   for the STEEPLE Investigators
Published: October 2008

Objective: To evaluate the impact of sheath management on bleeding rates. Background: The procedural characteristics and anticoagulant regimen determine the frequency of postoperative bleeding complications following percutaneous coronary intervention (PCI). Methods: This subanalysis of the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial evaluated the relative impact of enoxaparin or unfractionated heparin (UFH) on the rate of non‐coronary artery bypass graft‐related major and minor bleeding, according to sheath management procedures in 3,528 patients undergoing elective PCI with a femoral approach. Results: Sheaths were removed at a median time of 54 min with enoxaparin 0.5 mg/kg, compared with 3 hr 14 min with enoxaparin 0.75 mg/kg and 2 hr 24 min with UFH. Early sheath removal (within 30 min from the end of PCI) was associated with reduced bleeding in patients receiving 0.5 or 0.75 mg/kg enoxaparin compared with UFH (enoxaparin 0.5 mg/kg: 4.9% vs. 10.8%; P < 0.001; enoxaparin 0.75 mg/kg: 5.0% vs. 10.8%; P < 0.001). Compared with UFH, major and minor bleeding was halved when enoxaparin (0.5 mg/kg and 0.75 mg/kg) was used in combination with a closure device (4.4% and 5.3% vs. 10.5% with UFH) or smaller (<7 Fr) sheath sizes (4.9% and 6.0% vs. 9.3%). Conclusion: This analysis shows that early sheath removal can be performed safely following elective PCI in patients receiving enoxaparin. Enoxaparin use was associated with less major and minor bleeding compared with UFH, when either a closure device or a smaller sheath size was used. © 2009 Wiley‐Liss, Inc.
Outcomes with drug‐eluting stents versus bare metal stents in acute ST‐elevation myocardial infarction: Results from the Strategic Transcatheter Evaluation of New Therapies (STENT) Group
Authors: Brodie Bruce R. , Stuckey Thomas , Downey William , Humphrey Angela , Nussbaum Marcy , Laurent Sherry , Bradshaw Barbara , Metzger Chris , Hermiller James , Krainin Fred , Juk Stanley , Cheek Barry , Duffy Peter , Simonton Charles A. ,   for the Strategic Transcatheter Evaluation of New Therapies (STENT) Group
Published: October 2008

Objectives:

This study compares outcomes with drug‐eluting stents (DES) versus bare metal stents (BMS) in patients with ST‐elevation myocardial infarction (STEMI).

Background:

DESs have been effective in elective percutaneous coronary intervention (PCI), but their safety and efficacy in patients with STEMI have not been well studied.

Methods:

The STENT Registry is a multicenter United States registry evaluating outcomes of DES. Our study population includes patients with STEMI treated with either a DES or BMS who completed 9‐month or 2‐year follow‐up. Outcomes were adjusted using propensity score analysis.

Results:

DES patients were younger, had less prior infarction and prior bypass surgery, but had smaller vessels and longer lesions. After adjusting for differences in baseline variables, there were no significant differences between DES and BMS in death, reinfarction, or major adverse cardiac events (MACE). DES had lower rates of stent thrombosis at 9 months (1.0% vs. 2.7%, HR 0.40 [0.17–0.95]) and lower rates of target vessel revascularization (TVR) at 9 months (4.0% vs. 7.5%, HR 0.55 [0.34–0.88]) and 2 years (8.0% vs. 11.3%, HR 0.57 [0.35–0.92]). There was a nonsignificant increase in stent thrombosis with DES versus BMS from 1 to 2 years (1.1% vs. 0.3%, P = 0.28).

Conclusions:

Our data suggest that DES used with primary PCI for STEMI are more effective than BMS in reducing TVR and are safe for up to 2 years. Whether DES are safe beyond 2 years and whether the reduction in TVR is enough to justify their use in STEMI will have to wait for the results of large randomized trials. 2008 Wiley‐Liss, Inc.
Percutaneous closure of an iatrogenic atrial septal defect
Authors: Sur James P. , Pagani Francis D. , Moscucci Mauro
Published: October 2008

The use of the Tandem Heart™ percutaneous ventricular assist device (Tandem Heart pVAD, Cardiac Assist technologies, Pittsburgh, PA) as a bridge to recovery or to other cardiopulmonary support systems has been rising. One requirement for placement of this device is an intraatrial septostomy which is usually closed during the surgical insertion of more permanent ventricular assist devices. We present a case of a 62‐year‐old man with a residual acquired atrial septal defect (ASD) from Tandem Heart™ placement, which could not be closed surgically during insertion of left and right ventricular assist devices. The patient remained intubated and hypoxemic after removal of his right ventricular assist device due to the presence of persistent right to left shunting. With closure of the ASD using an 8‐mm Amplatzer® septal occluder (ASO; AGA Medical Corp., Golden Valley, MN) the patient stabilized and was successfully extubated. © 2009 Wiley‐Liss, Inc.
Left main coronary artery compression from right pulmonary artery stenting
Authors: Hamzeh Rabih K. , El‐Said Howaida G. , Moore John W.
Published: October 2008

Complications related to pulmonary artery stenting include stent migration, jailing of vessels, vessel rupture, and compression of surrounding structures. Compression of the left main coronary artery (LMCA) as a result of stent placement in the right pulmonary artery (RPA) is extremely rare. We present two patients post repair of congenital heart disease who suffered LMCA compression following RPA stenting. The first patient experienced acute coronary insufficiency in the cardiac catheterization laboratory, whereas the second patient had a more chronic course. We also present a third patient who had a CT angiogram that demonstrated a close spatial relationship between the RPA and the LMCA. Based on our previous experiences, we felt that this patient was at significant risk for LMCA compression if the RPA were stented. Coronary compression is rare complication of pulmonary artery stenting but should be considered in cases with history of repaired congenital heart disease. © 2009 Wiley‐Liss, Inc.
Occupational health hazards in the interventional laboratory: Time for a safer environment
Authors: Klein Lloyd W. , Miller Donald L. , Balter Stephen , Laskey Warren , Naito Neil , Haines David , Ross Allan , Mauro Matthew A. , Goldstein James A.
Published: October 2008

Over the past 30 years, the advent of fluoroscopically guided interventional procedures has resulted in dramatic increments in both X‐ray exposure and physical demands that predispose interventionists to distinct occupational health hazards. The hazards of accumulated radiation exposure have been known for years, but until recently the other potential risks have been ill‐defined and under‐appreciated. The physical stresses inherent in this career choice appear to be associated with a predilection to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight and design of personal protective apparel worn to reduce radiation risk and to the poor ergonomic design of interventional suites. These occupational health concerns pertain to cardiologists, radiologists and surgeons working with fluoroscopy, pain management specialists performing nonvascular fluoroscopic procedures, and the many support personnel working in these environments.

This position paper is the work of representatives of the major societies of physicians who work in the interventional laboratory environment, and has been formally endorsed by all. In this paper, the available data delineating the prevalence of these occupational health risks is reviewed and ongoing epidemiological studies designed to further elucidate these risks are summarized. The main purpose is to publicly state speaking with a single voice that the interventional laboratory poses workplace hazards that must be acknowledged, better understood and mitigated to the greatest extent possible, and to advocate vigorously on behalf of efforts to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward the ultimate zero radiation exposure work environment that would eliminate the need for personal protective apparel and prevent its orthopedic and ergonomic consequences. © 2008 Wiley‐Liss, Inc.
Long‐term mortality after bolus‐only administration of abciximab, eptifibatide, or tirofiban during percutaneous coronary intervention
Authors: Marmur Jonathan D. , Poludasu Shyam , Lazar Jason , Cavusoglu Erdal
Published: October 2008

Objective:

To evaluate the long‐term mortality after bolus‐only administration of abciximab, eptifibatide, and tirofiban during percutaneous coronary intervention (PCI).

Background:

Studies on platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) administered as bolus‐only during PCI suggest that this strategy may be similar in efficacy, safer, and more cost‐effective compared to a bolus plus infusion of GPI.

Methods:

We evaluated 864 patients (abciximab = 274, eptifibatide = 361, and tirofiban = 229) who underwent PCI with a bolus‐only regimen during January 2003 to August 2005.

Results:

After a median follow up of four (interquartile range, 3–4.5) years, there were a total of 95 (11%) deaths. The survival rate was 83% in the abciximab group, 91% in the eptifibatide group, and 93% in the tirofiban group (P = 0.003 by log‐rank test). After adjustment for baseline clinical and procedural characteristics using a Cox proportional hazards model, the abciximab group had a significantly higher mortality compared to the eptifibatide group (P = 0.003; Hazard ratio (HR) for eptifibatide compared to abciximab was 0.49 (95% confidence intervals [CI]: 0.30–0.78). The long‐term mortality was not significantly different in the tirofiban group compared to the abciximab group (P = 0.33) or the eptifibatide group (P = 0.20), perhaps because of shorter follow‐up period and fewer patients in the tirofiban group.

Conclusion:

When given as bolus‐only during PCI, eptifibatide may improve long‐term survival compared to abciximab. © 2009 Wiley‐Liss, Inc.
Hemolysis induced pancreatitis after orbital atherectomy in a heavily calcified superficial femoral artery
Authors: Mehta Sameer K. , Laster Steven B.
Published: October 2008

Orbital atherectomy represents a newly developed technology for the endovascular treatment of peripheral artery disease. There is currently limited data with regards to the safety and efficacy of this treatment. Herein, we describe a case where orbital atherectomy was utilized to treat a heavily calcified superficial femoral artery, and describe a previously unreported side effect of orbital atherectomy, hemolysis induced pancreatitis. © 2008 Wiley‐Liss, Inc.
Percutaneous aortic valve implants under sedation: Our initial experience
Authors: Behan Miles , Haworth Peter , Hutchinson Nevil , Trivedi Uday , Laborde Jean‐Claude , Hildick‐Smith David
Published: October 2008

Objectives:

We have developed an approach where percutaneous aortic valve (PAVI) procedures are done under remifentanil‐based sedation administered by an anesthetist. We report here our initial experience.

Background:

Percutaneous aortic valve implantation is proving to be an effective treatment for aortic stenosis in patients with significant comorbidity precluding surgical aortic valve replacement. Most PAVIs have been done under general anesthetic with transoesophageal echocardiography (TOE). General anesthesia in this patient group is hazardous and associated with significant complications.

Methods and Results:

CoreValve implantation was performed via the retrograde approach in 12 patients at our cardiothoracic center between December 2007 and May 2008. Three had the procedure under general anesthetic and nine under sedation. There were no differences between the groups in terms of comorbidities and clinical characteristics. The procedure was visualized using fluoroscopic aortic calcification coupled with multiple small volume aortograms. One patient converted from sedation to general anesthetic during the procedure. One patient in the general anesthetic group died from respiratory complications. There were no significant differences in procedural success, procedure time, or hospital stay between the two groups.

Conclusion:

Percutaneous aortic valve implantation can, in the majority of cases, be performed under remifentanil‐based sedation. Our initial experience suggests that this should result in a shorter implant procedure time, reduced stay in high dependency areas, and shorter time to hospital discharge. © 2008 Wiley‐Liss, Inc.
Transient contrast encephalopathy after carotid artery stenting mimicking diffuse subarachnoid hemorrhage: A case report
Authors: Fang Hsiu‐Yu , Kuo Yeh‐Lin , Wu Chiung‐Jen
Published: October 2008

Several types of brain injury incurred during carotid artery stenting (CAS), such as embolic injury, hemodynamic events, and hemorrhage. Rapid differential diagnosis is important for decision making, and may help to avoid subsequent complications. Here, we describe a case with severe triple vessel coronary artery disease, who underwent right coronary artery (RCA) stenting and ad hoc left CAS. Patient developed neurological deficit two hours after the procedure. Brain computed tomography (CT) revealed diffuse cortical enhancement similar to subarachnoid hemorrhage (SAH). Patient recovered dramatically with complete resolution of contrast enhancement after four days of conservative treatment, final diagnosis was a rare reported case of transient contrast encephalopathy. © 2008 Wiley‐Liss, Inc.
In vitro and in vivo studies on thermistor‐based intracoronary temperature measurements: Effect of pressure and flow
Authors: Cuisset Thomas , Beauloye Christophe , Melikian Narbeh , Hamilos Michalis , Sarma Jaydeep , Sarno Giovanna , Naslund Maria , Smith Leif , Van de Vosse Frans , Pijls Nico HJ , De Bruyne Bernard
Published: October 2008

Background:

Intracoronary thermography has been proposed to detect vulnerable plaques. We hypothesized that changes in coronary pressure and flow in the coronarytree may interfere with the temperature measurements obtained with thermistors.

Methods and Results:

First, a very close correlation was found in vitro between the temperature measured by a thermocouple and by a thermistor‐based temperature measuring guide wire (PressureWire, PW) over a large temperature range. Second, the PW was tested in a vitro low pressure model of “hot plaque”. The sensor of the PW could detect changes in temperature of the wall of 0.5°C as long as the distance from the wall was less than 0.5 mm and the flow less than 60 mL/min. Third, in 18 patients with an acute myocardial infarction, intracoronary pressure and temperature variations were assessed. Although crossing the occlusion, the temperature rose by 0.059 ± 0.02°C and this increase was correlated with the distal coronary pressure (r = 0.72, P < 0.001). Fourth, a balloon coronary occlusion (BCO) with the sensor distally in the distal part of the vessel (low flow/low pressure conditions) systematically induced an increase in temperature (0.14 ± 0.07°C) while with the sensor proximally to the balloon occlusion (low flow/normal pressure conditions), no change occurred.

Conclusion:

Taken together these observations suggest that thermistor‐based sensors are not suited for assessing thermal heterogeneity in the vascular wall and that the data obtained so far in patients with acute coronary syndromes might have been flawed by pressure (and flow) artifacts. © 2009 Wiley‐Liss, Inc.
Antiplatelet drug response variability and the role of platelet function testing: A practical guide for interventional cardiologists
Authors: Angiolillo Dominick J. , Suryadevara Siva , Capranzano Piera , Zenni Martin Z. , Guzman Luis A. , Bass Theodore A.
Published: October 2008

Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndrome and is also of particular importance in those who undergo percutaneous coronary intervention with stent implantation. Dual antiplatelet therapy with aspirin and clopidogrel is associated with improvement in long‐term clinical outcomes in such patients and is presently the antiplatelet therapy of choice for secondary prevention of thrombotic events. However, a significant number of patients experience recurrent events despite antiplatelet therapy. Although poor patient compliance can account for some of these events, particularly in those patients who receive a drug‐eluting stent, increasing evidence indicates that there is variability in response to antiplatelet therapy and patients who have higher levels of platelet reactivity are at increased risk for recurrent ischemic events. However, the lack of a consistent definition of inadequate platelet response, as well as the lack of a standardized measurement technique, has made it difficult to define how to treat these patients. To translate findings associated with variability in platelet response into improved patient care, it is necessary to gain a better understanding of what variable platelet response is, how it is measured, who it should be measured in, and what its clinical relevance is. The objective of this review is to evaluate the data regarding interindividual response variability to antiplatelet therapy with the aim of providing practical considerations and where possible, recommendations, regarding this topic for interventional cardiologists. © 2008 Wiley‐Liss, Inc.
Stenting of stenotic or occluded iliofemoral veins, superior and inferior vena cavae in children with congenital heart disease: Acute results and intermediate follow up
Authors: Frazer Jeffrey R. , Ing Frank F.
Published: October 2008

Objectives:

To determine the short and intermediate term outcome following systemic venous stent placement in children with congenital heart disease.

Background:

Patients with congenital heart disease are at risk of stenosis or occlusion of systemic veins following indwelling lines or catheterizations. Stent dilation may ameliorate symptoms and open the vessel for use during future procedures. We report our acute and intermediate results.

Methods:

All patients with systemic venous stent placement in the iliofemoral veins, inferior or superior vena cava at our institution between 1998 and 2006 were included. Initial and the follow‐up catheterization data were reviewed retrospectively.

Results:

70 stents were placed in 33 patients (36 vessels). Median age was 2.6 years (0.2–14.2) and weight 11.5 kg (3.8–78.7). 17/36 vessels (47%) were occluded requiring recanalization. Following stent delivery, the mean minimum vessel diameter increased from 3.1 ± 3.2 to 7.2 ± 3.0 mm (P < 0.001). There were no major complications. Seventeen patients and vessels had a total of 62 follow‐up catheterizations, with median length of follow‐up 4.1 years (0.7–9.3). During intermediate follow up, 7/17 vessels (41%) required additional intervention. Six patients had additional balloon dilation of existing stents, and one additional stent was placed. Vessels were further dilated to 8.4 ± 3.5 mm at the last catheterization.

Conclusion:

Systemic venous stents are safe and effective in recanalizing stenosed or occluded vessels. At follow‐up, reocclusion can occur, however, previously placed stents can be safely recanalized if necessary. Future studies will determine if stenting is indicated in a broader population. © 2009 Wiley‐Liss, Inc.