bluuebunny/crossref_metadata_2025 huggingface dataset:
Timing of the restenosis following nitinol stenting in the superficial femoral artery and the factors associated with early and late restenoses
Authors: Iida Osamu , Uematsu Masaaki , Soga Yoshimitsu , Hirano Keisuke , Suzuki Kenji , Yokoi Hiroyoshi , Muramatsu Toshiya , Inoue Naoto , Nanto Shinsuke , Nagata Seiki
Published: July 2011

Objectives: We sought to investigate the timing of restenosis and the restenosis factors following nitinol stenting in the superficial femoral artery (SFA). Background: Restenosis following nitinol stenting in the SFA remains unsolved. Methods: We analyzed 742 limbs in consecutive 585 patients who underwent successful endovascular therapy for de novo SFA lesions. Patency was assessed by duplex ultrasonography. Primary patency was defined as treated vessels without restenosis and secondary patency was defined as target vessels reopened by repeat revascularization. Receiver‐operating characteristic (ROC) analysis was performed to delineate the timing of restenosis. Patients were subsequently classified into three groups: no restenosis, early restenosis, and late restenosis. Cox proportional hazard regression analyses were performed to explore the determinants of restenosis in each restenosis group. Results: Primary and secondary patency was 67 and 86% at 6 years, respectively. ROC curves indicated the 369th day was the best cutoff point distinguishing the early (144 limbs) and the late (42 limbs) restenoses. Sustained patency was observed in 556 limbs. After multivariate analysis, cilostazol (P = 0.0007) was negatively associated; female gender (P = 0.0071), diabetes mellitus (P = 0.0428), critical limb ischemia (P = 0.0435), and stent fracture (P = 0.0004) were positively associated with the early restenosis. Trans Atlantic Inter‐Society Consensus II C/D was positively associated with both the early (P = 0.0017) and the late (P = 0.0359) restenoses. Conclusions: Restenosis predominantly occurred within a year following nitinol stenting in the SFA, and the factors associated with the early restenosis were different from those with the late restenosis. © 2011 Wiley‐Liss, Inc.
Preprocedural hemoglobin predicts mortality following peripheral vascular interventions
Authors: Jaffery Zehra , Shamai Lior , White Christopher J.
Published: July 2011

Background: Serum hemoglobin (H) level is a well‐known predictor of all‐cause mortality in patients undergoing percutaneous coronary interventions but has not been studied in patients undergoing peripheral vascular interventions (PVI). We sought to determine the prognostic significance of serum H in patients undergoing PVI. Methods: We identified 346 consecutive patients undergoing PVI who had a documented a baseline and a postprocedural serum H level over a 33‐month period. A multivariate analysis of predictors of 9‐month mortality was performed. Results: Of 346 patients identified, there were 28 deaths (8.1%) over a 9‐month follow‐up period. Periprocedural H change was not associated with death [OR: 1.12 (95% CI: 0.71–1.79), P = NS]. In a multivariate model independent predictors of all‐cause mortality were clinical bleeding [OR: 10.7 (95% CI: 0.012–0.769), P = 0.026], emergency intervention [OR: 4.5 (95% CI: 0.07–0.71), P = 0.011], ejection fraction [OR: 1.02 (95% CI: 1.01–1.05), P = 0.020], and preprocedural H [OR: 1.56 (95% CI: 1.19–2.04) P = 0.001]. Conclusion: In patients undergoing PVI, preprocedural H was a significant predictor of 9‐month all‐cause mortality. The highest mortality rate was seen in patients with a preprocedural H level ≤ 10 g/dl. Preprocedural H level can be used in clinical practice to risk stratify patients being considered for PVI. Further investigation is needed to assess if optimization of H level preprocedure improves midterm mortality. © 2011 Wiley‐Liss, Inc.
Successful treatment for refractory coronary thrombus with scoring balloon angioplasty
Authors: Hosokawa Yusuke , Tanaka Keiji , Mizuno Kyoichi
Published: July 2011

A female with chronic atrial fibrillation presented with an acute myocardial infarction. The angiogram revealed total occlusion of the right coronary artery. A combined strategy using intracoronary thrombolysis, aspiration catheter, plain old balloon angioplasty, and “Fogarty‐like” procedure was performed. However, we failed to achieve good coronary flow because the thrombus was large and hard with a calcified surface revealed by intravascular ultrasound examination. Ultimately, compression of the thrombus with the AngioSculpt™ scoring balloon catheter (AngioScore, Fremont, CA) led to resolution of normal coronary flow without the need for implantation of a coronary stent. Calcified thrombus is rarely observed in a coronary artery embolism, especially one formed in the left atrial appendage. In this case, the AngioSculpt scoring balloon catheter shows efficacy in treating this calcified thrombus. © 2011 Wiley Periodicals, Inc.
Protein‐losing enteropathy resolved by percutaneous intervention
Authors: Butera Gianfranco , Marini Davide , MacDonald Simon T.
Published: July 2011

The extracardiac total cavopulmonary connection is the final stage of palliation of hearts with single‐ventricle physiology. Protein‐losing enteropathy (PLE) and plastic bronchitis are catastrophic sequale that may occur in patients with the total cavopulmonary connection and may complicate the early and long‐term follow‐up. Here we report on the successful treatment of a 16‐year boy affected by PLE by percutaneous closure of a persistent anterograde pulmonary blood flow by using an 8‐mm Amplatzer VSD Occluder. © 2011 Wiley‐Liss, Inc.
Qualitative comparison of coronary angiograms between 4 french catheters with an Advanced Cardiovascular Injection System and 6 french catheters with manual injection
Authors: Gonzalez Manuel A. , Ben‐Dor Itsik , Gaglia Michael A. , Torguson Rebecca , Shimellis Hirity , Bui Anh , Suddath William O. , Pichard Augusto D. , Satler Lowell F. , Waksman Ron
Published: July 2011

Objectives: This study aimed to test whether advanced cardiovascular injection (ACI) via 4 French (Fr) catheters is more advantageous than manual injection with 6 Fr catheters. Background: For coronary angiography, proponents of contrast media ACI believe it utilizes smaller‐diameter catheters when compared with manual injection, without compromising the quality of the angiogram, and has the potential to reduce the amount of contrast used and lessen the use of closure devices. Methods: In a prospective study, 200 consecutive patients referred for elective coronary angiography were randomized to standard 6 Fr catheters with manual injection versus 4 Fr catheters with ACI. The study's primary endpoint is the quality of the coronary angiogram. Secondary endpoints include groin complications, utilization of closure devices, and volume of contrast media. Thirty‐six patients who underwent ad hoc percutaneous coronary intervention were excluded from the analysis. Results: The final analysis included 80 patients treated with 4 Fr catheters with ACI and 84 patients treated with 6 Fr catheters with manual injection. The groups had similar demographic and clinical characteristics. The quality of the angiogram was similar between groups with the exception of more left coronary sinus flush with 4 Fr catheters (3.57 ± 1.1 vs. 2.98 ± 0.9, P < 0.001) and less closure device use with 4 Fr (25 vs. 71.4%, P < 0.01) compared to 6 Fr catheters. The procedure duration, volume of contrast used, vascular complications, and time to ambulation were similar between groups (all P > 0.05). Conclusions: 4 Fr diagnostic catheters with ACI offer similar quality coronary angiograms, similar rates of vascular complications, procedure duration, contrast used, and time to ambulation, but have a significantly lesser need for closure devices compared to the 6 Fr system with manual injection. © 2011 Wiley‐Liss, Inc.
Assessment of macro‐ and microcirculation in contemporary critical limb ischemia
Authors: Kawarada Osami , Yokoi Yoshiaki , Higashimori Akihiro , Waratani Naoto , Fujihara Masahiko , Kume Teruyoshi , Sakata Kenji , Honda Yasuhiro , Fitzgerald Peter J.
Published: July 2011

Objectives: A paucity of data exists regarding manifestations of macro‐ and microcirculation in contemporary critical limb ischemia (CLI). The aim of this study was (1) to evaluate the differences in foot circulation based on angiographic findings, (2) to clarify the relationship between macro‐ and microcirculation, and (3) to investigate the effects of postural changes on micro as well as macrocirculation between the supine position to the dependent position. Methods: A total of 40 critically ischemic limbs in 29 patients were included in this study. Noninvasive evaluation of macrocirculation, based on the ankle brachial index (ABI) and ankle pressure, and microcirculation, using skin perfusion pressure (SPP), was performed in both the supine and dependent positions. Results: There was no significant difference in macro‐ and microcirculations between any angiographical involvements. In the supine position, dorsal SPP correlated significantly with ABI (P = 0.021, r = 0.363) and ankle‐pressure (P = 0.001, r = 0.495), whereas plantar SPP failed to correlate with ABI (P = 0.198, r = 0.208) or ankle‐pressure (P = 0.185, r = 0.214). In the dependent position, however, SPP showed no significant correlation with ABI and ankle pressure. Postural change from the supine to dependent position yielded a significant increase in SPP (dorsal: 37.2 ± 16.2 to 77.9 ± 17.7 mm Hg, P < 0.001; plantar: 33.6 ± 17.3 to 75.7 ± 18.3 mm Hg, P < 0.001) as well as ABI and ankle‐pressure (ABI: 0.70 ± 0.35 to 0.78 ± 0.42, P = 0.003; ankle‐pressure; 108 ± 61 to 111 ± 60 mm Hg, P = 0.038). The effect of postural change on SPP showed no difference between patients with and without any clinical and angiographical complications. Conclusions: Of microcirculation assessed, only dorsal SPP correlated significantly with macrocirculation in the supine position. Furthermore, postural change from the supine to dependent position produced a dramatic improvement in microcirculation due to the effects of gravity. © 2011 Wiley Periodicals, Inc.
Comparison of long‐term outcomes of drug‐eluting stents and bare metal stents for saphenous vein graft stenosis
Authors: Chakravarty Tarun , Morrissey Ryan P. , Wertman Brett , Naghi Jesse , Chou Stanley , Goykhman Pavel , Doctor Niraj , Mirocha James , Forrester James S. , Makkar Raj
Published: July 2011

Objective: Our aim was to compare the long‐term outcomes between drug‐eluting stents and bare‐metal stents for saphenous vein graft stenosis. Background: The ideal type of stent to treat saphenous vein graft stenosis has not been clearly established. Short‐term randomized controlled trial results comparing drug‐eluting stents with bare‐metal stents for saphenous vein graft stenosis are conflicting, intermediate‐term retrospective studies and meta‐analyses at two years suggest no difference in outcomes, and there are no long term follow‐up studies. The need for long term follow‐up data has become emerged with concern over late stent thrombosis. Methods: 246 saphenous vein graft patients undergoing stenting from August 2002–December 2008 were studied. Overall survival and event‐free survival were compared by Kaplan‐Meier method. Hazard ratios (HR) were calculated by Cox‐proportional hazards models. Results: We treated 133 patients with DES (median follow‐up four years) and 113 patients with BMS (median follow‐up four years) for SVG stenosis. Overall survival (77.0% ± 3.9% vs. 70.6% ± 4.6%, log‐rank P = 0.60) and MACE‐free survival (57.5% ± 4.6% vs. 56.8% ± 4.9, log‐rank P = 0.70) were not significantly different between the DES and BMS groups. Although BMS was associated with increased risk of target lesion revascularization (TLR) (freedom from TLR 85.2% ± 3.5% vs. 90.0% ± 3.0%, HR 2.07, 95% CI 0.97–4.42, log‐rank P = 0.05), there was no significant difference in the freedom from myocardial infarction (86.7% ± 3.3% vs. 88.7% ± 3.2%, log‐rank P = 0.39) or target vessel revascularization (77.1% ± 4.2% vs. 76.1% ± 4.2%, log‐rank P = 0.33) between the two groups. Conclusions: Although mortality is not statistically different between DES and BMS for SVG stenosis, BMS is associated with increased risk of revascularization, thus suggesting the superiority of DES over BMS in the long term. © 2011 Wiley Periodicals, Inc.
Stent migration during transcatheter management of coarctation of aorta
Authors: Kannan Bhava R.J. , Srinivasan Muthusamy
Published: July 2011

A 13‐year‐old girl underwent endovascular stent placement for coarctation of aorta. The fully expanded stent migrated to ascending aorta which could be stabilized, recrimped, and repositioned with a 20‐mm goose neck snare. Postdilatation was performed from the left brachial route resulting in a good outcome. © 2011 Wiley Periodicals, Inc.
Transfemoral use of the guideLiner catheter in complex coronary and bypass graft interventions
Authors: Luna Michael , Papayannis Aristotelis , Holper Elizabeth M. , Banerjee Subhash , Brilakis Emmanouil S.
Published: July 2011

The GuideLiner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange catheter that allows deep vessel intubation. We describe 21 patients in whom the GuideLiner catheter [7 French (F) in 76% and 6F in 24%] was used to facilitate equipment delivery (n = 14) or vessel engagement (n = 7). Pressure dampening after GuideLiner catheter insertion was observed in 12 patients (57%). The procedure was successfully completed in 19 patients (90%) and one patient developed acute vessel closure, likely due to dissection. The GuideLiner catheter can facilitate complex coronary interventions but should be used with caution to minimize the risk for vessel injury. © 2011 Wiley Periodicals, Inc.
Clinical outcome of transcatheter aortic valve implantation in patients with low‐flow, low gradient aortic stenosis
Authors: Gotzmann Michael , Lindstaedt Michael , Bojara Waldemar , Ewers Aydan , Mügge Andreas
Published: July 2011

Background: Low‐flow, low‐gradient aortic stenosis is associated with relevant postoperative mortality whereas conservative management results in dismal prognosis. We present the initial experience of low‐flow, low‐gradient aortic stenosis treated with transcatheter aortic valve implantation (TAVI). Methods: From June 2008 to December 2010 167 consecutive patients with native severe aortic stenosis and an excessive operative risk underwent TAVI. Of these, 15 patients presented with low‐flow, low‐gradient aortic stenosis (aortic valve area < 1 cm2, left ventricular (LV) ejection fraction < 40%, aortic mean gradient < 40 mm Hg). The CoreValve prosthesis 18‐F‐generation (Medtronic, Minneapolis, Minnesota) was inserted retrograde. Clinical follow‐up and echocardiography were performed 6 months after procedure. Results: Patients with low‐flow, low‐gradient aortic stenosis (mean LV ejection fraction 32 ± 6%, mean aortic gradient 27 ± 7 mm Hg) had higher all‐cause mortality 6 months after TAVI compared to patients without low‐flow, low‐gradient aortic stenosis (33% vs. 13%, P = 0.037). In the surviving 10 patients with low‐flow, low‐gradient aortic stenosis, LV ejection fraction increased (34 ± 6% before vs. 46 ± 11% 6 months after TAVI, p = 0.005) and more distance covered in the 6‐minute walk test (218 ± 102 meters before vs. 288 ± 129 meters 6 months after TAVI, p = 0.038). Conclusion: Our study suggests that TAVI is feasible in patients with severe co‐morbidities and low‐flow, low‐gradient aortic stenosis. Within the first 6 months after treatment all‐cause mortality was considerable high, but the surviving patients showed symptomatic benefit and significant improvement of myocardial function and exercise capacity. © 2011 Wiley Periodicals, Inc.
Percutaneous revascularization of left main
Authors: Palmerini Tullio , Alessi Laura , Rizzo Nicole , Dangas George
Published: July 2011

Refinement of interventional techniques, adjunctive pharmacological therapy, and the introduction of drug‐eluting stents have fostered new interest for the percutaneous treatment of unprotected left main coronary artery (ULMCA) stenosis. Several observational registries, some randomized trials and several meta‐analyses have consistently shown no difference in mortality and myocardial infarction between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with ULMCA stenosis, but a higher rate of target vessel revascularization in patients treated with PCI. As a consequence, PCI of ULMCA stenosis has been upgraded to class IIa or IIb indication in the current European or American practice guidelines. However, several critical issues should be properly addressed when pursuing a percutaneous strategy for the treatment of ULMCA stenosis, such as the use of IVUS for procedural guidance, assessment of disease location, optimal technique for distal ULMCA stenosis, risk of stent thrombosis, optimal duration of dual antiplatelet therapy, and the most appropriate strategy for post‐procedure follow up. Multidisciplinary team approach remains essential to provide a balanced information to the patient and to offer the beast treatment option. © 2011 Wiley Periodicals, Inc.
Periaortic hematoma after transcatheter aortic valve replacement: Description of a new complication
Authors: Généreux Philippe , Reiss George R. , Kodali Susheel K. , Williams Mathew R. , Hahn Rebecca T.
Published: July 2011

We report a case series of three patients with periaortic hematomas following transcatheter aortic valve replacement (TAVR). The TAVRs were performed by either trans‐apical or transfemoral approach. An intraprocedural transesophageal echocardiogram (TEE) was performed in all patients. Clinical features of all three cases included advanced age, female gender, and small body weight. In addition, the following characteristics were present in all cases: presence of bulky calcification of the noncoronary cusp (NCC) of the aortic valve, mismatch between the annulus and device diameter, and severe intraprocedural hypertension immediately following TAVR. These characteristics may be potential causative factors. Early recognition of this complication by intra‐procedural TEE was integral to the initiation of rapid and appropriate therapy, resulting in a favorable outcome. Herein, we present possible theories for the occurrence of this rare complication. © 2011 Wiley Periodicals, Inc.
Unprotected left main coronary artery stenting with zotarolimus (Endeavor) drug‐eluting stents
Authors: Simard Trevor , Hibbert Benjamin , Chong Aun‐Yeong , Ruchin Peter , Le May Michel , Labinaz Marino , Froeschl Michael , So Derek , Glover Christopher , Marquis Jean‐Francois , O'Brien Edward
Published: July 2011

Objectives: To report the safety and efficacy of zotarolimus eluting stents for treatment of unprotected left main coronary artery disease. Background:Percutaneous stent insertion is an increasingly popular alternative to bypass surgery for the management of left main (LM) coronary artery disease. While data support the use of sirolimus‐ and paclitaxel‐coated stents in the LM coronary artery, there are no published series reporting results with Endeavor (zotarolimus) stents, particularly in the context of unprotected left main (ULM) lesions. Methods:We retrospectively identified 40 consecutive patients who had ULM disease treated with Endeavor stents (ZES) and who had follow‐up angiography. The primary endpoint was the prevalence of major adverse cardiac events (MACE), including cardiac/unexplained death, nonfatal myocardial infarction (MI), and in‐stent restenosis (ISR)/target lesion revascularization (TLR). Results:Angiographic and procedural success was achieved in all cases. Follow‐up angiography occurred on average 5.6 ± 0.9 months after the index procedure. There were three incidences of ISR requiring TLR and another patient who had a NSTEMI in the follow‐up period. At late follow‐up (12.4 ± 1.8 months) three patients underwent CABG (one for RCA stenosis) and four patients died without knowledge of the status of the ULM stent (two cardiovascular and two deaths related to cancer progression). Conclusions:In conclusion, our experience with Endeavor stents for the treatment of ULM disease demonstrates excellent angiographic and clinical outcomes, with a 7.5% ISR/TLR rate and a 15% MACE rate, respectively, at an average clinical follow‐up of 12.4 months. © 2011 Wiley Periodicals, Inc.
Tulip malformation of the left atrial disc in the lifetech cera ASD device: A novel complication of percutaneous ASD closure
Authors: Hayes Nicholas , Rosenthal Eric
Published: July 2011

A previously unreported tulip‐like malformation of the left atrial disc was encountered during percutaneous closure of an atrial septal defect (ASD) using the LifeTech Cera ASD device, requiring snare assistance to permit recapture into the delivery sheath. This was likely to be as a result of attempting to recapture the left atrial disc whilst it remained in contact with some part of the atrial septum or left atrial wall. To help avoid this, it is recommended to ensure complete intracavity positioning of the Cera device prior to retrieval into the sheath. © 2011 Wiley Periodicals, Inc.
A case of spontaneous multivessel coronary artery dissection presenting with acute myocardial infarction and ventricular tachycardia
Authors: Karabag Turgut , Dogan Sait M.
Published: July 2011

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia. Multivessel SCAD is much rarer than single vessel involvement and acute coronary syndrome remains the most common clinical presentation of a patient with SCAD. It predominantly occurs in association with atherosclerosis or in the absence of atherosclerosis. We, hereby, present a case of spontaneous multivessel coronary artery dissection in a 35‐year‐old male patient presenting with chest pain and ventricular tachycardia following emotional stress and discuss the etiology and treatment options. © 2011 Wiley‐Liss, Inc.
Kissing drug eluting balloons for in‐stent restenosis complicating bifurcations treated with drug‐eluting stents
Authors: Raja Yogesh , Doshi Sagar N. , Townend Jonathan N.
Published: July 2011

The management of in‐stent restenosis (ISR) complicating bifurcation lesions is technically challenging and implant of further stents may not be feasible. The use of drug‐eluting balloons provides an attractive option for treatment of such lesions allowing a technically simple procedure without the need for further complex stenting. The SeQuent Please paclitaxel‐eluting balloon (B. Braun, Berlin, Germany) has been shown to be superior to a paclitaxel eluting stent or balloon angioplasty for ISR complicating a bare‐metal stent. However, there is no data on the efficacy of the SeQuent Please in ISR complicating drug‐eluting stents or bifurcation lesions. We report two cases where the SeQuent Please was used in this setting with angiographic success and freedom from target vessel failure and angina at 24 months. In both cases the Sheathless Eau Cath guide (Asahi Intecc, Japan) was employed to perform a kissing‐balloon dilatation with the SeQuent Please, so allowing treatment via radial access. © 2012 Wiley Periodicals, Inc.
Needle in the haystack purulent pericarditis from injection drug use
Authors: Steiner Johannes , Dhingra Ravi , DeVries James T.
Published: July 2011

Central needle embolization is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Previously reported cases of needle embolization to the heart have been managed conservatively (observation alone) or by surgical intervention. We report a case of purulent pericarditis without evidence of valvular vegetations resulting from an embolized, infected needle fragment. In the present case, the needle was successfully removed from the right ventricle percutaneously. This case illustrates the unique finding of purulent pericarditis due to a persistent foreign body in the right ventricle, and the nontraditional intervention performed for needle fragment removal which resulted in full clinical recovery of the patient. © 2011 Wiley Periodicals, Inc.
Guideliner® catheter—Friend or foe?
Authors: Murphy John Conleth , Spence Mark S.
Published: July 2011

Performing percutaneous coronary intervention (PCI) in arteries with complex anatomy remains a clinical problem. In particular tortuosity within a coronary vessel is frequently encountered and can hamper delivery of balloons or stents to coronary stenoses. This has led to the development of a number of adjuvant devices to assist stent delivery in difficult cases. The safety profile of these novel devices remains to be clearly ascertained. The Guideliner® “child” support catheter is one such device and comprises of a 20‐cm silicon‐coated guide extension that assists delivery of stents in tortuous arteries when conventional techniques have failed. Initial reports suggest it is efficacious and no previous complications relating to the device have been published. We report the first complication involving the Guideliner® catheter which was encountered during primary PCI. We hypothesize regarding the mechanism of the complication and discuss the ways it may be avoided in the future. © 2011 Wiley Periodicals, Inc.
Correlation between index electrocardiographic patterns and pre‐intervention angiographic findings: Insights from the HORIZONS‐AMI trial
Authors: Rokos Ivan C. , Farkouh Michael E. , Reiffel James , Dressler Ovidiu , Mehran Roxana , Stone Gregg W.
Published: July 2011

Objectives: To improve ECG interpretation accuracy in patients with chest pain prior to activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PPCI). Background: Despite current guideline‐based ECG criteria, challenges remain in optimizing the rate of appropriate catheterization laboratory activation. Methods: The HORIZONS‐AMI trial enrolled 3,602 patients with chest pain consistent with myocardial infarction (MI). ECG and angiographic core laboratory databases were analyzed for correlation between the qualifying study ECG and the baseline coronary angiogram. Results: LAD occlusion manifested in >80% of cases as ST‐segment elevation in leads V2 and V3, while the culprit vessel was the RCA and LCx in 75 and 25% of cases, respectively, for inferior MI ECG patterns. The study threshold of ≥1.0 mm ST‐segment elevation in ≥2 contiguous ECG leads was not met in 189 (5.3%) patients. When stratified by culprit artery, the prevalence of reciprocal ST‐segment depression ranged from 24 to 88%, being least common for lesions in the mid‐ and distal left anterior descending artery. Despite study eligibility, no posterior MIs were enrolled. Only 36 LBBB cases were identified (25% of whom did not undergo PCI), and 5 of 11 left main coronary occlusions (45%) had ST‐segment elevation in lead aVR. Conclusions: The present study confirms prior ischemic ECG findings predicted by vectorcardiography, validates certain ECG patterns as reliable surrogate markers for acute coronary occlusion, and provides novel insights correlating index ECG ischemic changes and pre‐intervention coronary angiography. These results may enhance the rate of appropriate catheterization laboratory activation. © 2011 Wiley Periodicals, Inc.
Acute and 16‐month outcomes of a new stent: The first‐in‐man evaluation of the medtronic S9 (integrity) stent
Authors: Lee Stephen Wai Luen , Chan Michael P.H. , Chan Kelvin K.W.
Published: July 2011

Objective: A first‐in‐man evaluation of the safety, feasibility, deliverability, and efficacy of the new Medtronic S9 (Integrity) bare metal stent (BMS) in complex coronary diseases. Background: Excellent deliverability remains an unmet clinical need among stents especially in complex lesions. The S9 (Integrity) BMS utilizes a new, continuous sinusoidal manufacturing technology to enhance stent flexibility and deliverability, without sacrificing radial strength. Methods: This is a first‐in‐man, open label observational study in 15 patients treated with S9 (Integrity) BMS. Device success during implantation, clinical outcomes, 30‐day and 12‐month device‐oriented and patient‐oriented composite efficacy end‐points, and 16‐month angiographic restudy were evaluated (with amended protocols). Results: Thirty‐four stents were deployed to treat 30 complex lesions. Mean lesion length was 22.93 ± 11.78 mm, and mean percentage diameter stenosis was 78.59% ± 9.01%. Mean stent delivery time was 125 ± 68.3 sec. Acute device, lesion, and procedure success, as defined, were 100%. Device‐oriented and patient‐oriented composite end‐points were zero at 30 days. Two patients had ischemic driven revascularization before 12 months. One patient had non‐cardiac death at 13 months; all remaining 12 patients received 16 months angiographic restudy and only one had angiographic restenosis. The mean diameter of stenosis was 27.0% ± 18.3%, and mean late loss was 0.73 ± 0.50 mm. Total target vessel failure rate was 21.4% (3/14) at 16 months. Conclusion: The new S9 (Integrity) BMS exhibited excellent deliverability, flexibility, and conformability, contributing to good acute and 16 months outcomes in complex cases. © 2011 Wiley Periodicals, Inc.
Sirolimus‐eluting stent fracture detection by three‐dimensional optical coherence tomography
Authors: Okamura Takayuki , Matsuzaki Masunori
Published: July 2011

Stent fracture has emerged as a complication of drug‐eluting stent and is now recognized as contributing to in‐stent restenosis and possibly stent thrombosis. Although optical coherence tomography (OCT) can detect stent fractures in the absence of circumference struts, it is challenging to visualize stent fractures with only cross‐sectional OCT images. We describe two cases of restenosis with stent fracture detected by a novel three‐dimensional OCT image reconstruction technique. This technique allows identification of a single stent fracture even in the absence of angiographic signs. © 2011 Wiley Periodicals, Inc.
Cardiogenic shock secondary to severe acute ischemic mitral regurgitation managed with an impella 2.5 percutaneous left ventricular assist device
Authors: Harmon Laura , Boccalandro Fernando
Published: July 2011

We report a case of a patient successfully treated with an Impella Recover LP 2.5 (ABIOMED, Danvers, MA) left ventricular assist device, in the setting of cardiogenic shock secondary to severe acute mitral regurgitation associated with an acute myocardial infarction. © 2011 Wiley Periodicals, Inc.
Scanning electron microscopic assessment of coating irregularities and their precursors in unexpanded durable polymer‐based drug‐eluting stents
Authors: Basalus Mounir W.Z. , Tandjung Kenneth , van Westen Thea , Sen Hanim , van der Jagt Pasquelle K.N. , Grijpma Dirk W. , van Apeldoorn Aart A. , von Birgelen Clemens
Published: July 2011

Objectives: To assess and quantify coating irregularities on unexpanded and expanded durable polymer‐based drug‐eluting stents (DES) to gain insights into the origin of coating irregularities. Background: Previous scanning electron microscopy (SEM) studies in various expanded DES revealed differences in frequency and size of coating irregularities between DES types and specific distribution patterns, however, the origin of these irregularities is unclear. Methods: We assessed at bench side a total of 1,200 SEM images obtained in 30 DES samples (15 expanded and 15 unexpanded) of Cypher Select Plus, Taxus Liberté, Endeavor, Xience V, and resolute. Results: For most coating irregularities seen on expanded DES (72%; 23/32), a matching irregularity (n = 18/23) and/or its precursor (n = 11/23) was observed in unexpanded DES. Unexpanded Cypher select showed (small) crater lesions and cracks together with precursors of “peeling.” On unexpanded Taxus Liberté, thinning of polymer, small bare metal areas, wrinkles, and one precursor type were found. Unexpanded endeavor showed cracks, small bare metal areas, crater lesions, and precursors of the latter. Unexpanded Xience V and resolute mainly revealed crater lesions and their precursors. On unexpanded versus expanded DES, there was no difference in measured frequency of coating irregularities and precursors (P = ns) with the exception of more bare metal areas on expanded Taxus Liberte (P = 0.01). Conclusions: Most coating irregularities, or the potential to develop them, are inherent to the unexpanded DES. Important determinants of the formation of coating irregularities may be the stent geometry and the physical properties of the coating, while stent‐balloon interaction plays no major role. © 2011 Wiley Periodicals, Inc.
Randomized comparison of the nobori biolimus A9‐eluting stent with the sirolimus‐eluting stent in patients with stenosis in native coronary arteries
Authors: Kadota Kazushige , Muramatsu Toshiya , Iwabuchi Masashi , Saito Shigeru , Hayashi Yasuhiko , Ikari Yuji , Nanto Shinsuke , Fujii Kenshi , Inoue Naoto , Namiki Atsuo , Kimura Takeshi , Mitsudo Kazuaki
Published: July 2011

Objectives: The aim of this randomized‐controlled trial is to compare Biolimus A9‐eluting stent (Nobori) to sirolimus eluting stent (Cypher). Background: The Nobori coronary stent is coated only abluminally with a biodegradable polymer, poly‐lactic acid, and the antiproliferative agent Biolimus A9. This stent has been studied in randomized trials versus Taxus Express and Taxus Liberte and showed noninferiority and superiority for in‐stent late loss. This is the first randomized trial of Nobori stent versus Cypher stent. Methods: We conducted a randomized (3:2), controlled trial comparing Nobori and Cypher, in 335 patients (198 Nobori and 137 Cypher) at 15 centers in Japan. Patients with de‐novo lesions in up to two native coronary arteries were considered for enrollment. The primary endpoint was freedom from target vessel failure (TVF), a composite of cardiac death, myocardial infarction, and target vessel revascularization at 9 months. Results: At 9 months, the primary endpoint of freedom from TVF was 92.6% in Nobori and 93.8% in Cypher arm (noninferiority test P < 0.001). As main secondary endpoints, the in‐stent late loss was 0.12 ± 0.30 mm and 0.14 ± 0.34 mm in Nobori and Cypher stents, respectively. Target lesion revascularization was 0.5% in Nobori and 3.9% in Cypher treated patients (P = 0.04). Definite and probable stent thromboses were not recorded in any patient. Conclusions: Despite the relatively small number of patients, this well controlled clinical trial confirmed the primary hypothesis of non‐inferiority of the Nobori Biolimus A9‐eluting stent to the Cypher sirolimus‐eluting stent for freedom from TVF. Both stents showed excellent midterm results. © 2011 Wiley Periodicals, Inc.
Coronary artery aneurysms as seen on multidetector computed Tomography angiography
Authors: Roy Sion K. , Kadakia Jigar , Shittu Adekunle , Budoff Matthew J.
Published: July 2011

Coronary artery aneurysms (CAA) are present in 1.4–5.3% of the population (Nichols, Lagana, Parwani. Arch Pathol Lab Med 2008; 132:823–828). While angiography remains the gold standard for evaluating CAAs, multidetector computed tomography angiography (MDCTA) is an emerging way of assessing CAAs (Pahlavan and Niroomand. Clin Cardiol 2006;29:439–443). With the increasing clinical utilization of MDCTA, CAAs are often initially diagnosed using this method. Since MDCTA is used largely in lower risk and asymptomatic patients, understanding the etiology and treatment is paramount for clinicians reading these studies. © 2011 Wiley Periodicals, Inc.
The use of fluoroscopy to construct learning curves for coronary angiography
Authors: Jensen Ulf J. , Lagerquist Bo , Jensen Jens , Tornvall Per
Published: July 2011

Objectives: The aim of this study was to assess learning curves for coronary angiography using registry data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Background: ACC and ESC guidelines for cardiologists in training recommend 200–300 coronary angiographies as primary operator. Whether this is safe or sufficient to reach an adequate proficiency level is not known. The development of learning curves and factors that can determine progress is not yet clearly stated. Methods: We extracted data from SCAAR 2005–2009 and identified 20 novel and 21 expert operators in coronary angiography during this observation period. Metrics possibly influenced by proficiency level were compared between the two groups. Learning curves were then identified with the expert's performance as reference defined as interquartile range (IQR). Results: Data from a total of 24,000 coronary angiographies were examined. Beginners used similar volumes of contrast but had longer fluoroscopy time compared with experts. Fluoroscopy time appeared to be a metric that demonstrated a clear learning curve and beginners reached experts IQR in 50 % (median) of the procedures after ∼140 coronary angiographies. The risk of complications was independently associated with fluoroscopy time. Conclusions: Fluoroscopy time seems to be the best metric to determine coronary angiography performance level and might therefore be a good proficiency measure during training. On the basis of our results we recommend the trainee to perform at least 150 coronary angiographies during supervision before proceeding with unsupervised procedures. It is not clear if the suggested number of procedures will result in decreased number of complications but the data suggests that fluoroscopy time might be a surrogate marker for complications. © 2011 Wiley Periodicals, Inc.
How opening two chronic total occlusions may be easier than just one
Authors: Indermuhle Andreas , Thomas Martyn , Redwood Simon
Published: July 2011

Recanalization of chronic total occlusions (CTOs) via grafts has been described previously. However, the insertion of the graft into the distal vessel is often characterized by an unfavorable entry angle which renders an antegrade approach challenging. In the present case, we describe how retrograde recanalization of the proximal right coronary artery (RCA) via a right internal mammary artery graft facilitated antegrade revascularization of the CTO of the RCA. © 2012 Wiley Periodicals, Inc.
A comparative study of Cardi‐O‐Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects
Authors: Saritas Turkay , Kaya Mehmet Gungor , Yin Lam Yat , Erdem Abdullah , Akdeniz Celal , Demir Fadli , Erol Nurdan , Demir Halil , Celebi Ahmet
Published: July 2011

Aim: We sought to investigate the safety and efficacy of Cardio‐O‐Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). Methods: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple‐ (isolated defects <26 mm) or complex‐types (isolated defect ≥26 mm, double or multifenestrated defects). The procedures were guided by fluoroscopy and transthoracic or transesophageal echocardiography. Clinical and echocardiographic follow‐ups were arranged before discharge, at 1 month and then every 6‐month after implantation. Results: During the study period, 185 (125 males, aged 18.5 ± 15.6 years) and 166 (103 males, aged 21.0 ± 15.7 years) patients attempted CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions (17 vs. 16%, P = 0.796), procedural times and success rates (97% vs. 96%, P = 0.635) as compared to the ASO group. Acute residual shunts were less prevalent in CSO than ASO group and most shunts closed spontaneously at 6‐month follow‐ups. The average equipment cost per patient was lower in CSO group (US$ 4,100 vs. US$ 5,900, P < 0.001). The prevalence of device embolization and atrial arrhythmia (all <2%) were similar in both patient groups. Conclusion: Transcatheter ASD occlusion with CSO is safe and effective and it appeared to be an attractive alternative to ASO in closing simple‐type ASD because of its relatively low cost. © 2013 Wiley Periodicals, Inc.
Transcatheter closure of large patent ductus arteriosus at high altitude with a novel nitinol device
Authors: Heath Alexandra , Lang Nora , Levi Daniel S. , Granja Miguel , Villanueva Jorge , Navarro Joaquin , Echazú Gabriel , Kozlik‐Feldmann Rainer , del Nido Pedro , Freudenthal Franz
Published: July 2011

Background: Patent ducti arteriosi (PDAs) are more frequent and larger at high altitude than at sea level. A novel PDA closure device, the Nitocclud PDA‐R, is designed specifically for both large and medium size PDAs. The initial clinical experience with a new nitinol‐based device in high altitude patients with large PDAs is described. Methods: The Nitocclud PDA‐R is a self‐expandable, self‐centering, repositionable occluder made of one nitinol wire without use of welding. It contains several polyester membranes, is delivered with a central guide wire and is released by retraction of the central wire into the delivery catheter. The efficacy of this device was evaluated at several high altitude centers. Results: Fifty‐one patients without other congenital cardiac defects underwent transcatheter closure of PDA. Complete occlusion of the PDA was achieved in 98% of the patients. Nearly 49% of the patients had no shunt immediately after device implantation. Echocardiography revealed a complete closure rate by Doppler interrogation of 69% after 24 hr, 96% after 6 months, and 98% after 1 year. In two cases, device embolization was observed after release, and in both cases the device was easily retrieved with standard interventional techniques. There have been no episodes of delayed device migration, endocarditis, hemolysis, wire fracture, device disruption, or death. Conclusions: The Nitocclud PDA‐R device is safe and effective and can easily close very large PDAs. This device has a high rate of complete occlusion within 1 year and is easily retrieved if embolized. © 2011 Wiley Periodicals, Inc.
Gold and Copper Nanoparticles Supported on Cerium(IV) Oxide—A Photocatalyst Mineralizing Organic Acids under Red Light Irradiation
Authors: Tanaka Atsuhiro , Hashimoto Keiji , Kominami Hiroshi
Published: July 2011

Gold and copper nanoparticles supported on cerium(IV) oxide (CeO2) powder, which were prepared using a simple multistep photodeposition method, showed strong absorptions at around λ=620 nm attributed to the surface plasmon resonance of Cu‐Au nanoparticles and exhibited a higher level of activity than that of Au/CeO2 in the mineralization of organic acids (formic acid and acetic acid) in aqueous suspensions under light irradiation (λ=640 nm) from a red light‐emitting diode. The action spectrum in the mineralization of formic acid indicates that this mineralization involved a photoinduced step by the SPR of Cu‐Au supported on CeO2. The apparent quantum efficiency reached 7.5 % at λ=625 nm and 5.2 % even at λ=700 nm.
Nonvolatile Rewritable Memory Effects in Graphene Oxide Functionalized by Conjugated Polymer Containing Fluorene and Carbazole Units
Authors: Zhang Bin , Liu Yi‐Liang , Chen Yu , Neoh Koon‐Gee , Li Yong‐Xi , Zhu Chun‐Xiang , Tok Eng‐Soon , Kang En‐Tang
Published: July 2011

A new polymer, poly[{9,9‐di(triphenylamine)fluorene}(9,9‐dihexylfluorene)(4‐aminophenylcarbazole)] (PFCz) was synthesized and used in a reaction with graphene oxide (GO) containing surface‐bonded acyl chloride moieties to give a soluble GO‐based polymer material GO–PFCz. A bistable electrical switching effect was observed in an electronic device in which the GO–PFCz film was sandwiched between indium–tin oxide (ITO) and Al electrodes. This device exhibited two accessible conductivity states, that is, a low‐conductivity (OFF) state and a high‐conductivity (ON) state, and can be switched to the ON state under a negative electrical sweep; it can also be reset to the initial OFF state by a reverse (positive) electrical sweep. The ON state is nonvolatile and can withstand a constant voltage stress of −1 V for 3 h and 108 read cycles at −1 V under ambient conditions. The nonvolatile nature of the ON state and the ability to write, read, and erase the electrical states, fulfill the functionality of a rewritable memory. The mechanism associated with the memory effects was elucidated from molecular simulation results and in‐situ photoluminescence spectra of the GO–PFCz film under different electrical biases.
ChemInform Abstract: Structural and Complex AC Impedance Spectroscopic Studies of A2CoNbO6 (A: Sr, Ba) Ordered Double Perovskites.
Authors: Bashir J. , Shaheen R.
Published: July 2011

The title compounds are characterized by powder XRD and impedance spectroscopy.
ChemInform Abstract: [C4MPyr]2[Br20]: Ionic‐Liquid‐Based Synthesis of a Three‐Dimensional Polybromide Network.
Authors: Wolff Michael , Meyer Jens , Feldmann Claus
Published: July 2011

According to the alternative formulation [bmpyr]2[Br‐]2·9Br2 title compound (II) contains nine bromine molecules, the highest amount of bromine observed so far.
ChemInform Abstract: Flux Synthesis of Two New Organically Templated Zinc Phosphites with Different 3,4‐Connected Frameworks.
Authors: Wang Shidan , Luo Daibing , Luo Xiuchao , Chen Yaoqiang , Lin Zhieh
Published: July 2011

Compounds (II) are prepared by a phosphorus acid flux method without the addition of water as solvent.
ChemInform Abstract: Dy2(SO3)2(SO4) (H2O)2: The First Lanthanide Mixed Sulfate—Sulfite Inorganic Compound.
Authors: Zhang Zai‐Chao , Wang Jia‐Hong , Zhao Pu‐Su
Published: July 2011

The title compound is prepared by hydrothermal reaction of DyCl3 and Na2S2O3 (pH ≈5 adjusted with 1 M NaOH, 433 K, autoclave, 48 h; 54% yield).
ChemInform Abstract: Synthesis, Characterization, and Structure—Property Relationships in Two New Polar Oxides: Zn2(MoO4)(SeO3) and Zn2(MoO4)(TeO3).
Authors: Nguyen Sau Doan , Kim Sang‐Hwan , Halasyamani P. Shiv
Published: July 2011

The new isostructural compounds (IV) and (VI) are characterized by single crystal XRD, IR and UV/VIS spectroscopy, second harmonic generation, piezoelectric, and polarization measurements, and DFT calculations.
ChemInform Abstract: Synthesis and Crystal Structure of a Novel Boratotungstate: Pb6B2WO12.
Authors: Li Junjie , Pan Shilie , Zhao Wenwu , Tian Xuelin , Han Jian , Fan Xiaoyun
Published: July 2011

The new title compound is synthesized by solid state reaction of a stoichiometric mixture of WO3, PbO, and H3BO3 at 540 °C for 20 h.
ChemInform Abstract: Selective, Nickel‐Catalyzed Hydrogenolysis of Aryl Ethers.
Authors: Sergeev Alexey G. , Hartwig John F.
Published: July 2011

The aromatic C—O bonds in diaryl, aryl alkyl, and benzyl alkyl ethers are selectively cleaved under 1 bar hydrogen in the presence of a soluble nickel carbene catalyst at max.
ChemInform Abstract: Highly Active Ruthenium(II) Complex Catalysts Bearing an Unsymmetrical NNN Ligand in the (Asymmetric) Transfer Hydrogenation of Ketones.
Authors: Ye Wenjing , Zhao Miao , Du Wangming , Jiang Quanbin , Wu Kaikai , Wu Ping , Yu Zhengkun
Published: July 2011

Newly synthesized ruthenium(II) complexes bearing an unsymmetrical pyridyl‐benzimidazolyl‐based ligand exhibit high catalytic activity for transfer hydrogenations of aromatic and cyclic ketones.
ChemInform Abstract: Poly(vinyl)chloride Supported Palladium Nanoparticles: Catalyst for Rapid Hydrogenation Reactions.
Authors: Hemantha Hosahalli P. , Sureshbabu Vommina V.
Published: July 2011

A wide range of nitro, carbonyl, azido and imine groups is efficiently hydrogenated in the presence of PVC‐supported Pd nanoparticles.
ChemInform Abstract: Aerobic Oxidation of Thiols to Disulfides Catalyzed by Diaryl Tellurides under Photosensitized Conditions.
Authors: Oba Makoto , Tanaka Kazuhito , Nishiyama Kozaburo , Ando Wataru
Published: July 2011

It allows an efficient access to a wide range of disulfides.
ChemInform Abstract: Highly Regio‐ and Diastereoselective Anionic [3 + 2] Cycloaddition under Phase Transfer Catalytic Conditions.
Authors: Gembus Vincent , Postikova Svetlana , Levacher Vincent , Briere Jean‐Francois
Published: July 2011

In the presence of AMI, the allylic sulfones (Ia) and (IV) undergo highly regio‐ and diastereoselective [3 + 2] cycloaddition with enones to afford trans‐substituted cyclopentenes of type (III)/(VI).
ChemInform Abstract: Cryptococcus laurentii as a New Biocatalyst for the Asymmetric Reduction of Substituted Acetophenones.
Authors: Kurbanoglu Esabi B. , Zilbeyaz Kani , Kurbanoglu Namudar I.
Published: July 2011

More than 70% of the ketones are reduced with almost complete conversion.