bluuebunny/crossref_metadata_2025 huggingface dataset:
Low or High Iodine Content of Contrast Medium for Cardiac Angiography?
Authors: WASER MARCO , KAUFMANN URS , LUESCHER THOMAS , MEIER BERNHARD
Published: June 2007

Objective: To compare the diagnostic yield and the costs of a contrast agent with a lower iodine concentration, ioversol 300, versus the routinely used ioversol 350. Design and patients: In a prospective, randomized, double‐blind study, ioversol 300 (group A patients) containing 300 mg/mL of iodine was compared with the commonly used ioversol 350 (group B patients) containing 350 mg/mL of iodine using a visual scoring system (1 = worst, 5 = best) with respect to image quality, fluoroscopy time, and amount of contrast and iodine used for coronary angiography and left ventriculography in 300 consecutive patients. The study was performed in two catheterization laboratories of different technical standards (high resolution with digital image treatment stored on Super VHS tapes in patients 1–170 and conventional 35‐mm cine films in patients 171–300). Results: In group A, the quality scores for coronary angiography and left ventriculography were 4.4 (±0.7) and 4.0 (±0.8) in patients 1–170 and 3.7 (±0.8) and 4.0 (±0.8) in patients 171–300, whereas in group B the values were 4.4 (±0.6) and 4.5 (±0.6) for patients 1–170 and 3.7 (±0.8) and 4.0 (±0.8) for patients 171–300 (all NS). Fluoroscopy time (min) in group A was 9.4 (±6.1) in patients 1–170 and 11.1 (±8.8) in patients 171–300 and 11.0 (±6.6) and 10.1 (±5.7) in group B, respectively (NS). Contrast volume (mL) and iodine amount (g) in group A were 201.1 (±55.4) and 60.3 (±16.6) for patients 1–170 and 198.2 (±46.4) and 59.3 (±13.9) for patients 171–300 (NS). In group B, the corresponding numbers were 202.4 (±61.7) and 70.8 (±21.6) in patients 1–170 and 200.0 (±49.4) and 70.0 (±17.3) in patients 171–300 (P = 0.0042, patients 1–170 and P = 0.0002, patients 171–300 for iodine amount). The average cost of the contrast agent (Swiss francs) was 185.85 ± 47.9 in group A and 204.40 ± 52.4 in group B (P < 0.001). Conclusion: The use of ioversol 300 reduced the total iodine burden for cardiac catheterization with unaltered image quality and fluoroscopy time, while the costs were reduced by 9.1%.
Bare Stent Implantation Through a Side Slot of Another Stent in a Bifurcation Lesion
Authors: ANTONELLIS IOANNIS P. , PATSILINAKOS SOTIRIOS P. , PAMBOUCAS CONSTANDINOS A. , SALACHAS ANASTASIOS J. , KRANIDIS ATHANASIOS J. , MARGARIS NIKOLAOS G. , IFANTIS GEORGE P. , TAVERNARAKIS ANTONIOS G. , ROKAS STYLIANOS G.
Published: June 2007

A case of a patient with significant (≈ 90%) stenosis of the circumflex at its origin from the left main artery and of the first marginal branch, 20 mm after its origin from the circumflex, is described. The case was treated with implantation of two stents, one at the marginal and another at the circumflex through a side slot of the first stent.
An Unusual Presentation of Right Ventricular Myocardial Ischemia
Authors: FARRELL TIMOTHY P. , TISCHLER MARC D.
Published: June 2007

Electrocardiographs presentation of right ventricular myocardial ischemia can be varied but usually involves signs of inferior myocardial infarction (Ml) or ischemia. We present a case of a young male with an electrocardiogram consistent with an acute anterior MI successfully treated with thrombolytic therapy. Subsequent cardiac catheterization revealed complex coronary anatomy. Ergonovine maleate infusion and continuous 12‐lead electrocardiogram (ECG) monitoring in the catheterization laboratory allowed us to make the diagnosis of spasm of the right coronary artery and right ventricular branch as the cause of this patient's symptoms.
Guiding of Percutaneous Transcoronary Septal Myocardial Ablation in Hypertrophic Obstructive Cardiomyopathy by Myocardial Contrast Echocardiography:
Authors: FABER LOTHAR , SEGGEWISS HUBERT , FASSBENDER DIETER , STRICK STEFAN , GLEICHMANN ULRICH
Published: June 2007

Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol injection into septal branches (SB) of the left coronary artery has evolved as a promising therapeutic option for selected patients with obstructive hypertrophic cardiomyopathy (HOCM). Originally, probatory balloon occlusion of the target vessel was considered to be predictive for definitive reduction of left ventricular outflow gradients (LVOTG). The need for additional information regarding the exact site and extension of the therapeutic septal infarction is demonstrated by a case report. In this patient, myocardial contrast echocardiography (MCE) was performed prior to alcohol injection and showed that the septal area corresponding to LVOTG formation was supplied by a SB originating atypically from an intermediate branch. PTSMA guided by MCE led to complete LVOTG elimination without sustained rhythm disturbances and with a minimum CK rise.
Future Uses of Stents
Authors: HAUSDORF GERD
Published: June 2007

Stents are used in pediatric cardiology for a large variety of indications, but most often to enlarge stenotic vessels resulting in a defined diameter, as the elastic recoil of currently used stents is minimal. Experimentally, stents are used as a carrier for the implantation of valves or vessels, investigative is the use of stents as an occlusive device. Several novel indications have evolved for stents in pediatric cardiology: stenting of aortopulmonary collateral arteries, stenting of the ductus arteriosus in duct dependent congenital heart disease, stenting of the right ventricular outflow tract, and the use of stents to perform interventional completion of univentricular circulation.
Transcatheter Atrial Septal Defect Closure with the Das™ Angel Wings Transcatheter ASD Occlusion Device: The Cincinnati‐Rochester Experience
Authors: MENDELSOHN ALAN M. , BANERJEE ANIRBAN , SCHWARTZ DAVID C. , DAS GLADWIN S.
Published: June 2007

The Angel Wings Das device, a recently developed transcatheter atrial septal defect occluder, represents a new approach to therapy of this congenital cardiac lesion. Overall, successful defect occlusion occurs in > 90% of patients following device implantation. We describe the major design and technical issues pertinent to this device and review both international and personal local FDA Phase I trial results and complications. Future trial plans and device modifications are discussed.
The CardioSEAL Device: History, Techniques, Results
Authors: LATSON LARRY A.
Published: June 2007

The CardioSEAL™ Septal Occlusion Device is the current version of a type of transcatheter closure device developed in the early 1980s. It is a direct modification of the Bard Clamshell Septal Occluder, which was first utilized in humans in 1988. Modifications include the use of a metal alloy, which is far more resistant to fatigue fractures, and the addition of a second stress relieving coil along the length of each arm. Trials with the current version of the CardioSEAL device began in late 1996. Preliminary results from the CardioSEAL study indicate that the CardioSEAL device should be implantable in over 95% of selected patients. Acute transient events have been seen in <3% of procedures, and long‐term morbidity or mortality has been <1%. The device is not necessarily immediately occlusive, and approximately two thirds of patients have evidence of a small residual shunt at the time of implantation. Any residual leaks tend to decrease or resolve over time. Longer‐term results from the original Clamshell study support the long‐term safety and efficacy of this type of device. It is anticipated that 85%–90% of patients treated with the CardioSEAL device will have no further need of intervention and can be spared the need for open heart surgery.
Role of Infection in the Pathogenesis of Coronary Artery Disease
Authors: SAIKKU PEKKA
Published: June 2007

The idea of the role of infection in coronary artery disease (CAD), although not new, has gained increasing attention in recent years. Both viral and bacterial infections have been associated with the inflammation found in lesions. There are numerous direct and indirect ways by which a chronic infection could participate in the process and, moreover, acute infectious episodes could cause imbalance in these processes. For herpes group viruses, cytomegalovirus, and HSV type 1, there is seroepidemiological evidence, and viral nucleic acids have been found in lesions. Among bacteria, Helicobacter pylori, dental infections, and Chlamydia pneumoniae have been associated with CAD. The evidence is strongest for C pneumoniae, a Gram‐negative, obligatory intracellular bacterium known to cause chronic inflammations. The association has been demonstrated in numerous seroepidemiological studies, and recent studies have indicated the ubiquitous presence of C pneumoniae in atherosclerotic lesions. Four laboratories have developed an animal model for C pneumoniae‐induced atherosclerosis, and two preliminary intervention trials have been encouraging. Herpes virus vaccines are being developed and ongoing intervention studies will provide the answer as to whether antibiotics should be added to the treatment of CAD, a multifactorial disease.
Treatment of Ostial Lesions
Authors: MARGOLIS JAMES R. , GALLARELLO FRANCESCA
Published: June 2007

Ostial lesions have long been the bane of interventional cardiologists. Complication rates have been high, and restenosis rates even higher. Newer devices and stents have improved early and late results, but there is room for further improvement. The broad category of ostial stenoses includes an eclectic group of lesions that have some features in common, but differ in many respects. Previous reports have grouped all ostial stenoses as if they were identical. This has led to confusion regarding treatment and rates of complications and restenosis. It is our opinion that each type of ostial stenosis has its unique best treatment, and that treatment strategies are best individualized to the lesion at hand. The best general approach to ostial lesions of all kinds is debulking followed by stenting. In larger ostia, stenting is almost always appropriate. In smaller ostia, debulking alone may be better. We use all available debulking devices on a regular basis. The excimer laser is the most useful device for ostial disease. It allows the use of standard wires, double‐wire, and kissing balloon techniques and is technically easy. Most ostial disease requires stenting. By debulking first, stents can be placed more easily and more reliably, and full stent expansion is assured. Special stenting techniques are appropriate for ostial lesions. It is essential to assure that the proximal portion of the stent covers the ostium. We present tips and tricks that are specific for ostial disease.
Treatment Strategies for Long and Calcified Lesions
Authors: DE GREGORIO JOSEPH , COLOMBO ANTONIO
Published: June 2007

This study discusses the treatment strategies used to approach long lesions, lesions in small vessels, and calcified lesions. Traditional treatment strategies for these lesion subtypes have yielded high acute complication rates and poor long‐term outcome. A prospective analysis of 160 lesions was performed using intravascular ultrasound (IVUS) guided PTCA for the treatment of long lesions and lesions in small vessels, while a retrospective analysis of 106 calcified lesions was performed that were treated with the combination of rotablation and stenting. Acute and short‐term results of TVUS guided PTCA with spot stenting show a 30‐day major adverse cardiac event rate (MACE) of 5% with a high procedural success rate (96%), while the long‐term outcome resulted in an agiographic restenosis rate of 17.4% and a target lesion revascularization rate of 13%. The combination of rotablation and stenting also rendered results in calcified lesions of a 93% angiographic success rate and a long‐term outcome of restenosis of 22.5%. Optimal coronary stenting after rotational atherectomy in calcified lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results obtained with other interventional approaches. IVUS guided PTCA with spot stenting allows safe treatment of long lesions and lesions in small vessels. Short‐term and long‐term outcomes including 6‐month MACE and angiographic restenosis appear to be better than results achieved in historical controls that utilize balloon angioplasty alone or stents in a manner where the lesion is covered from the proximal normal segment to the distal normal segment.
Comparison of Restenosis Rate in Various Devices for Coronary Intervention: Analysis Using Vessel Diameter and Lesion Length
Authors: SUZUKI TAKAHIKO
Published: June 2007

The purpose of this study was to retrospectively compare the restenosis rates related to vessel diameter and lesion length among plain old balloon angioplasty (POBA), cutting balloon (CB) angioplasty, Palmaz‐Schatz (PS) stems, Gianturco‐Roubin (GR) stents, and directional coronary atherectomy (DCA). In 909 consecutive successfully treated cases, target lesion dimensions were divided into diameters of ± 2.5 mm and lengths of ± 20 mm to compare the restenosis rates obtained by the individual devices. Quantitative angiographic analysis was performed before the procedure, after the procedure, and at FU angiography at a mean FU time of 6 ± 3 months. Restenosis was defined as %DS > 50 at FU angiography. Patients with acute myocardial infarction, chronic total occlusions, left main lesions, ostial as well as venous graft lesions, severe calcifications, severe coronary thrombosis, and bleeding complications were excluded. The overall restenosis rate was 32%, with the CB it was 29%, with the PS stent it was 27%, and with DCA it was 39%. Each of these restenosis rates was significantly lower than that with POBA. The overall restenosis rate with short lesions at small vessels was 35%, while CB angioplasty yielded 29%, being significantly lower compared to that obtained by POBA. The overall restenosis rate with long lesions at small vessels was 53%. With those lesions there was no significant difference among the devices. The overall restenosis rate with short lesions at large vessels was 27%, with CB angioplasty it was 24%, with the PS stent it was 22%, and with DCA it was 25%. These restenosis rates were significantly lower compared to POBA. With long lesions at large vessels, the overall restenosis rate was 44%. In this subgroup, there was again no significant difference among the devices. Our study suggests that restenosis rates with short lesions are lower after CB angioplasty, stenting, and DCA, when compared to POBA. However, in the presence of long lesions, no difference was found among the devices.
Abdominal Aorta Aneurysm and ELG: A Review of a Treatment in Its Infancy
Authors: HEUSER RICHARD R. , LOPEZ ALEJANDRO
Published: June 2007

The literature on endoluminal stent grafting (ELG) treatment of abdominal aortic aneurysms (AAA) is primarily descriptive and anecdotal. We sought to compare the success rates of the different categories and types of AAA ELGs and find the 30‐day complication rate.
The Challenges of Today's Endovascular Interventions
Authors: NGUYEN THACH , HU DAYI , NGUYEN JAMES , SAITO SHIGERU , DAVE VIJAY
Published: June 2007

Endovascular interventions are considered the main therapeutic treatment modality for many vascular occlusive diseases. New indications emerge as short‐ and long‐term successes are reported. For new devices, there is a need to determine the superiority of one device or technique over another. Evaluation of these techniques is further complicated by the fact that the alternative therapeutic options (medical and surgical management) also are undergoing progressive refinement. While some of these results have been validated through state‐of‐the‐art and expensive clinical trials, others are supported only by limited observational data due to lack of sufficient funding or restrictive regulations. New and modified devices allow cardiac interventionists to perform more complicated procedures and successfully treat more complex lesions in sicker and older patients. Still, there are many limitations such as diffuse lesions, poor distal run‐off, or too small vessels. Another limitation is that the procedure is not affordable for the majority of patients. There are many unanswered questions regarding the techniques, strategies, and effectiveness of these new modalities of treatment. Only through additional studies and the passage of time will we know the answers to these questions.
Update on Stent Implantation in Acute Myocardial Infarction
Authors: SAITO SHIGERU
Published: June 2007

Primary stent implantation in acute myocardial infarction (AMI) is defined as the intentional (not rescue) implantation of intracoronary stent(s) to the culprit lesion of AMI during emergency catheterization. All available data showed that this strategy has favorable short‐ and long‐term clinical effects compared to primary balloon angioplasty.
Update on Management of In‐stent Restenosis
Authors: HERMILLER JAMES B. , FRY EDWARD T.A. , PETERS THOMAS F. , ORR CHARLES M. , TASSEL JAMES VAN , WALLER BRUCE F. , PINKERTON CASS A.
Published: June 2007

In‐stent restenosis (ISR) is a common and frequently resistant problem. The pathophysiology of in‐stent and nonstent restenosis is different, the former resulting primarily from intimal hyperplasia, while the latter is predominantly a consequence of negative late remodeling. Predictors of ISR are patient and lesion related. When approaching a patient with stent restenosis, false or pseudo‐restenosis must be considered. Angiography frequently fails to reveal pseudo‐restenosis, and, consequently, intravascular ultrasound can be essential in guiding the most effective strategy. Because of spontaneous neointimal regression, patients with asymptomatic stent restenosis often can be followed and treated medically. The mechanical approaches to ISR include balloon angioplasty alone, debulking plus PTCA, and restenting. For focal lesions (< 10 mm in length) balloon angioplasty at moderately high pressures is often effective. Following balloon dilatation, stent expansion and plaque extrusion equally account for the gain in lumen area. For more diffuse disease, debulking plus balloon angioplasty is preferred, although no randomized data are available. Only restenting is associated with a gain in MID that is comparable to the original stent implant and is not associated with reintrusion of neointima — INSTANT restenosis. Despite aggressive debulking with or without further stenting, diffuse stent restenosis often is resistant to purely mechanical treatment. Nonmechanical approaches, such as localized radiation therapy, will be required to effectively treat this difficult subset of patients.
Update on Endovascular Repair of Abdominal Aortic Aneurysms
Authors: MCNAMARA MARIAN F.
Published: June 2007

Endovascular repair is feasible in a large percentage of internal aneurysms. Multiple prototype devices have been inserted during clinical trials in the United States and Europe. This procedure can be performed in high risk patients with initial low morbidity and mortality. Endoleak is a complication specific to endovascular repair. Many endoleaks resolve spontaneously and others can be treated with additional endovascular procedures. Delayed rupture with endoleak can occur. Long‐term results for endovascular repair of abdominal aortic aneurysms are not yet available. The procedure has excellent patient acceptance and decreased recovery time as well as shortened hospitalization.
Update on Lower Extremity Endovascular Interventions
Authors: ROCHA‐SINGH KRISHNA J.
Published: June 2007

In the past decade there have been major strides in the development of devices and techniques for nonsurgical lower extremity revascularization. These advances have broadened indications for endovascular therapies and expanded the treatment options for patients with peripheral vascular disease. A variety of new laser‐etched steel and nitinol stent designs now complement balloon angioplasty. In the iliac segment, stenting has replaced balloon angioplasty as the first‐line therapy for treatment of symptomatic occlusive disease. Stenting results in superior acute procedural success and long‐term clinical efficacy compared to balloon angioplasty and is a “less invasive” alternative to surgical reconstruction. Endoluminal stent grafts offer promise in the treatment of high‐risk patients with abdominal aortic aneurysms. New strategies are being developed to address the diverse nature of the superficial femoral artery (SFA) and infrapopliteal disease where balloon angioplasty, stenting, and stent graft strategies have proven unsatisfactory for treatment of diffuse disease and long occlusions. The next millennium will see the use of “therapeutic angiogenesis,” the intravascular and intramuscular administration of DNA fragments or proteins, to stimulate new vessel growth in patients not amenable to conventional surgical or endovascular therapies. Brachytherapy, the intravascular delivery of a retrievable ionizing radiation source, represents an exciting development that offers the potential of reducing restenosis in the SFA.
Update on Percutaneous Mechanical Mitral Commissurotomy
Authors: CRIBIER ALAIN , ELTCHANINOFF HÉLÈNE , KONING RENÉ , RATH PRATAP C. , ARORA RAMESH , IMAN ADEL , EL‐SAYED MUSTAPHA , DANI SAMEER , DERUMEAUX GENEVIÈVE , JANORKAR SATEJ , LETAC BRICE
Published: June 2007

A reusable metallic valvotomy device has been developed with the goals of improving the results of percutaneous mitral valvotomy and increasing the cost‐effectiveness of the procedure. The device consists of a detachable and reusable metallic dilator with two articulated bars screwed at the distal end of a catheter. Using transseptal catheterization, the device is placed across the valve over a traction guidewire and then opened gradually by means of pliers up to a maximum of 40 mm. To date, the device was used in 168 patients with a broad spectrum of mitral valve disease. The procedure was successful in 95% of cases and resulted in an increase in mitral valve area from 1.01 ± 0.8 to 2.20 ± 0.7 cm2. No increase in mitral regurgitation was noted in 87% of cases. Bilateral splitting of the commissures was observed in 89%. Complications included the following: 2 severe mitral regurgitations (one requiring surgery), 1 pericardial tamponade, 1 transient cerebrovascular embolic event. The maximum number of consecutive patients treated with the same device was 35. The results obtained are at least comparable to those of current balloon techniques and confirm the possibility of safe multiple reuses of the device after sterilization.
Update on Extractional Thrombectomy Catheter, AngioJet™
Authors: NOBUYOSHI MASAKIYO , NAKAGAWA YOSHIHISA
Published: June 2007

Acute coronary syndromes are associated with intracoronary thrombus, which has been a risk factor for unfavorable outcome after percutaneous transluminal coronary angioplasty (PTCA). The AngioJet (Possis Medical, Inc. Minneapolis, MN, USA) catheter was developed to remove intravascular thrombus by hydrostatic suction without dilatation of the underlying plaque. It prepares the vessel for subsequent safe and uncomplicated intervention, including stenting. In acute total occlusion in acute myocardial infarction, the amount of thrombus, the severity of the underlying stenosis, or the tortuosity of the artery cannot be evaluated accurately, so there is a possibility of failure to pass the AngioJet catheter through the lesion. In spite of these limitations, the AngioJet still could be used successfully to remove thrombus from coronary arteries, and thrombus removal makes subsequent stenting uncomplicated. This successful experience supports a call for a larger scale prospective study of this thrombectomy approach.
Update on Intravascular Ultrasound
Authors: WEISSMAN NEIL J.
Published: June 2007

Intravascular ultrasound (IVUS) has moved from being predominately a research tool at tertiary interventional centers to a clinical instrument used routinely to assess interventional success and resolve diagnostic challenges. Advances in instrumentation technology, along with emerging clinical data, have contributed to the wider application of IVUS. However, there are number of practical limitations that must be overcome to integrate intravascular ultrasound into the catheterization laboratory. It is novel to many experienced interventionalists and its use requires appropriate training and experience. This article reviews the technological advances in catheter, transducer, and imaging systems design and recent and emerging clinical trials.
Update on Rotational Atherectomy
Authors: FELDMAN TED , REISMAN MARK
Published: June 2007

The Rotablator (Heart Technology, Inc., Redmond, WA, USA) atherectomy catheter, in essence, is a sanding device. Its effect is related to the size of the diamond particles and the force with which they are applied to the lesion. It removes calcified atheroma, which is the primary mechanism of lumen enlargement (vs vessel stretching), without causing recoil on 24‐hour angiography following rotational atherectomy. Rotational atherectomy finds its greatest use in patients with smaller vessels, calcified lesions, and complex or long coronary artery disease. These patients require a large armamentarium of devices and approaches to achieve optimal results. The ability to combine atherectomy, angioplasty, and stenting in these complex lesion subsets promises the best short‐term results and the largest lumen diameters with least residual stenoses and the best potential for good acute results and durable long‐term results.
Update of Coronary Doppler Flow Measurements
Authors: GE JUNBO , BHATE RAHUL , BAUMGART DIETRICH , ERBEL RAIMUND
Published: June 2007

As percutaneous coronary revascularization was performed on an increasing number of patients, the indications of many procedures were considered inappropriate because of the lack of objective evidence of significant coronary stenosis. This problem is the result of the limitations of noninvasive tests in assessing the physiological significance of a lesion and poor correlation between anatomy shown by quantitative coronary angiography and physiology of the stenosis. Even with intracoronary ultrasound study, the correlation between morphology and physiological significance has been poor, especially with lesions of intermediate severity. With recent technical improvements, measurement of coronary flow reserve (CFR) by Doppler catheters was advocated as the “gold‐standard” in assessing the physiological significance of epicardial coronary artery stenosis. Advantages and limitations of various Doppler indices commonly used in the catheterization laboratory were discussed. Because of its simple applicability, ease of validation using a clearly cut‐off value, virtual freedom from confounding factors, and usefulness even in the presence of triple vessel disease, fractional flow reserve (FFR) was found to be a better index for physiological assessment than absolute CFR or relative CFR.
Update on Catheter Ablation for Atrial Fibrillation
Authors: GUO CHENJUN , HU DAYI , YANG XINCHUN , SHANG LIHUA , BUMP THOMAS
Published: June 2007

Atrial fibrillation (AF) is a common arrhythmia that can be treated with antiarrhythmic drugs and electrical cardioversion. New therapies such as the automatic implantable atrial defibrillator, multisite atrial pacing, and catheter ablation are being studied extensively. Ablation for AF is in its infancy. There are different mechanisms of AF, and, therefore, there can be no single approach to therapy. One question is whether radiofrequency electricity (RF) is the best source of energy for catheter ablation for AF. RF results have been disappointing for the treatment of ventricular tachycardia, presumably because of the small size of the lesions that are produced. Other sources of energy such as microwave energy, which produces larger and deeper lesions, may be necessary in the future. RF might be modified to produce a larger lesion, perhaps by cooling the ablating electrode so that neighboring myocardium does not become charred and a higher dose of electricity can be delivered with greater penetration into deeper layers of myocardium. These efforts at producing larger lesions must be tempered by close attention to maintaining a high level of safety. AF usually is not immediately life threatening, thus a risky therapy will not be acceptable. The procedure should not expose the patient to excessive procedural time or an excessive radiation dose. From laboratory and clinical evidence, it is clear that a catheter ablation cure for some forms of AF will become available in the future, as long as our understanding of the mechanisms of AF continues to increase and ablative techniques continue to evolve.
Percutaneous Myocardial Laser Revascularization
Authors: OESTERLE STEPHEN , NGUYEN THACH , ALLEN KEITH
Published: June 2007

Transmyocardial laser revascularization (TMR) is an experimental procedure for intractable angina that has demonstrated clinical benefit. The majority of patients who had TMR have significant reduction of angina. TMR has been performed exclusively by thoracic and cardiac surgeons using a handhold CO2 laser device. The development of a prototype percutaneous device that delivers mid‐infrared laser energy (Ho:YAG) through a 9Fr coaxial catheter system recently has been reported. The long‐term benefits of this percutaneous approach is being defined in the context of the randomized PACIFIC Trial. The initial follow‐up suggested significant relief of angina in the majority of treated patients, and the results are likely to be equal or similar to those of surgical TMR. The safety data of percutaneous myocardial revascularization (PMR) with the CardioGenesis system showed exceedingly low morbidity and mortality.
Ischemic Attacks and Patent Foramen Ovale: Transcatheter Closure of Patent Foramen Ovale in Adults with Cryptogenic Systemic Embolism
Authors: CHATTERJEE TUSHAR , AESCHBACHER BEAT C. , MEIER BERNHARD
Published: June 2007

In the presence of a patent foramen ovale with otherwise unexplained (cryptogenic) cerebral embolism, the usual therapy is oral anticoagulation or antiplatelet therapy. Surgery is considered only in cases of recurrence. Percutaneous transcatheter occlusion of the patent foramen ovale (PFO) is a new valuable alternative. This article presents the current knowledge and our data concerning nonsurgical closure of patent foramen ovale to prevent paradoxical arterial embolism. Transcatheter PFO closure represents an elegant therapeutic approach in patients with suspected paradoxical embolism because it avoids open heart surgery and is minimally invasive. Even if the recurrence rate of embolism were identical, transcatheter closure would be preferable to anticoagulation because the annual risk of bleeding complications of 2%‐3% and the long‐term costs of anticoagulation can be avoided. Randomized studies are needed to compare transcatheter closure of patent foramen ovale with anticoagulation, platelet inhibitors, or surgery.
Transcatheter Vascular Occlusion: The Gianturco‐Grifka Vascular Occlusion Device in Infants and Children
Authors: GRIFKA RONALD G.
Published: June 2007

Transcatheter interventional procedures have become increasingly important for the treatment of congenital heart defects. Several devices are available for use in the United States; each device is effective for only a limited number of defects. Thus, there remains a need for additional safe and effective transcatheter occlusion devices. We developed a new transcatheter device that consists of a nylon sack attached to an end‐hole catheter. A wire is advanced through the catheter into the sack. The wire coils, filling the sack, occluding the vessel, and providing transmural pressure to maintain the sack position. Prior to releasing the device, it may be repositioned, removed, or exchanged for a different size device. The device is available in four sizes (3, 5, 7, and 9 mm). We evaluated this device in an animal model, occluding subclavian and carotid arteries, and surgically created aortopulmonary shunts. All vessels were occluded completely without complication. This device can occlude a tubular patent ductus arteriosus (PDA), aortopulmonary collateral, arteriovenous fistula, aneurysm, synthetic graft, vessel supplying a tumor, or other vascular structure. The device received approval from the Food and Drug Administration (FDA), and we have used the device to occlude various cardiovascular defects including: PDA, aortopulmonary collateral vessels, and intrapulmonary arteriovenous malformations. The results have been excellent. There are only two limitations to using the device; an 8Fr sheath is needed to deliver the device, and the vessel must be long enough for the sack to contact firmly against the vessel wall. When compared to other occlusion devices, this device has several advantages: the ability to reposition the device or remove it prior to release, several different sizes, and the device conforms to many vascular shapes making it another important tool in the transcatheter armamentarium.
Improved Short‐Term Outcomes of Primary Coronary Stenting Compared to Primary Balloon Angioplasty in Acute Myocardial Infarction at Experienced Centers: The PAMI Study Group Experience
Authors: STONE GREGG W. , BRODIE BRUCE R. , GRIFFIN JOHN J. , MORICE MARIE CLAUDE , COSTANTINI COSTANTINO , OVERLIE PAUL A. , LINNEMEIER THOMAS J. , MOSES JEFFREY , O'NEILL WILLIAM W. , GRINES CINDY L. ,   ON BEHALF OF THE PRIMARY ANGIOPLASTY IN MYOCARDIAL INFARCTION (PAMI) INVESTIGATORS
Published: June 2007

To study the additive benefits of routine stent implantation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) at experienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in Myocardial Infarction‐2 (PAMI‐2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI‐2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in‐hospital death (0.6% vs 2.7%, P = 0.03), reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revascularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 ± 4.4 vs 7.1 ± 6.2 days, P = 0.01). By multiple logistic regression analysis in 1,294 patients, stent implantation versus PTCA only was the strongest predictor of freedom from the composite in‐hospital end point of death, reinfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multivariate odds ratio = 0.4, P < 0.0001). These data strongly suggest that despite the excellent results achieved when primary PTCA is performed by experienced operators, the short‐term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.
Interventional Management of Acute Coronary Syndromes
Authors: TALLEY J. DAVID
Published: June 2007

Percutaneous coronary intervention is an effective treatment for a range of coronary syndromes. Although the success rate of the interventions has increased in recent years to more than 90%, percutaneous coronary procedures are still associated with short‐term and long‐term complications. The most common angiographic short‐term complication of balloon angioplasty is acute vessel closure. Clinically, periprocedural non‐Q wave myocardial infarctions are common during or immediately following the percutaneous intervention. These complications are associated with adverse clinical prognosis. Formation of platelet‐rich thrombi plays a major role in the pathophysiology of acute complications of balloon angioplasty. Potent platelet inhibition with glycoprotein IIb‐IIIa inhibitors reduces the incidence of periprocedural death and myocardial infarctions, a benefit that persists at long‐term follow‐up. The long‐term complication of percutaneous interventions is restenosis, which frequently requires repeated revascularization because of ischemic pain. Most pharmacological therapies have proved ineffective for the prevention of restenosis. This may not be surprising, as new evidence shows that the primary mechanism of restenosis may be arterial remodeling. Implantation of coronary stents prevents lumen narrowing due to the remodeling process, and coronary stenting significantly reduces the need for target vessel revascularization. Restenosis is not completely eliminated, however, and new treatment modalities aimed at prevention of in‐stent stenosis are actively being sought.
Balloon Catheter Fracture During Percutaneous Balloon Pericardial Window Formation—Retrieval of a Dislodged Balloon: A Case Report
Authors: LOPEZ GERARDO C. , LAW DAVID , JAIN ABNASH C.
Published: June 2007

During a balloon pericardial window formation we experienced a fracture of the balloon catheter causing dislodgment of the balloon. The balloon remained in the pericardial space. We describe a case report of this uncommon complication and a method for retrieval of the balloon.
Successful Treatment of a Stenosed Modified Blalock‐Taussig Shunt Using a Palmaz‐Schatz Stent: A Case Report
Authors: GOENKA SEEMA , SHOLES CHRISTOPHER W. , MEHTA ASHOK V.
Published: June 2007

Case report of a 15‐year‐old white male with complex cyanotic heart disease and multiple cardiac surgery including bilateral modified Blalock‐Taussig shunt. The patient developed worsening cyanosis and exercise intolerance for the last several months. He underwent percutaneous balloon angioplasty and placement of a PS 204 Palmaz‐Schatz balloon expandable stent for correction of severe stenosis at the junction of the right subclavian artery and a 6‐mm interposition Gore‐Tex graft. Since he was not a candidate for definitive surgery, this palliative procedure was performed to avoid repeat thoracotomy and to provide long‐term relief of the stenosis. Stent placement in children can be challenging due to vascular access and complex anatomy. We suggest long‐term follow‐up to validate the success of this procedure.
Considerations for the Multimodality Invasive Evaluation of the Cleft‐Like Coronary Arterial Lesion: Results from Intravascular Ultrasound Imaging, Flow, and Pressure
Authors: PURI SANJEEV , DONOHUE THOMAS J. , KERN MORTON J.
Published: June 2007

The assessment of coronary lesion severity is highly problematic for eccentric or cleft‐like stenoses. Using endovascular pressure, flow, and ultrasound imaging, a precise anatomical and physiological determination of lesion severity and decision to defer treatment was obtained. The multimodality approach to lesion assessment is reviewed.
Debate: Centering Is Important
Authors: POPOWSKI YOURI , VERIN VITALI
Published: June 2007

Since the first meetings dedicated to intracoronary radiation for restenosis prevention, the question of centering has been the subject of many debates. Today, more animal and clinical data are available, and some very preliminary conclusions can be drawn. From the radiation dosimetry standpoint, by allowing precise dose prescription, centering will allow the therapeutic window to be defined with greater accuracy. Moreover, because centering should lead to a lower dose to the arterial wall and a smaller irradiated volume compared with uncentered systems, centering could result in a reduction of radiation‐induced complications.
Prevention of Restenosis by External Beam Ionizing Irradiation
Authors: MOSSERI MORRIS , SCHWALB HERZL , WESHLER ZEEV
Published: June 2007

Intravascular brachytherapy with gamma sources has been proved to prevent in‐stent restenosis in recent clinical trials. Beta sources are also being investigated. The intravascular use of radioactive sources has raised theoretical and logistic problems and renewed the interest in teletherapy for the treatment and prevention of restenosis. We review the literature published on the use of teletherapy in animal models and compare it to brachytherapy from biological and logistic points of view. Developing technologies for stereotactic radiotreatment of moving targets may offer new solutions and are being studied.
Increased Apoptotic Cell Death in the Neointima after Stent‐Based Vascular Irradiation: Role of Radiation‐Induced Apoptosis for Restenosis Reduction
Authors: HEHRLEIN CHRISTOPH , KOLLUM MARC , ARAB AMINA , KAMENCIC HUSE , METZ JÜRGEN
Published: June 2007

Background: Restenosis after stent implantation is a common problem faced today by interventional cardiologists. It is primarily caused by excessive neointimal growth. Early clinical studies showed substantial reductions of neointimal volumes within bodies of32P radioactive coronary stents. Radiotherapy induces programmed cell death (apoptosis) in tumors but there is still debate whether irradiation causes apoptosis in arteries. Methods: We compared the time course of neointimal apoptosis after implanting 7‐mm long 32P radioactive slotted tubular stents in rabbit iliac arteries. The stents were homogeneously ion‐implanted with 32P at activity levels of 0.5 and 6 μCi. These stents produce continuous beta‐particle emission at very low dose rates. Neointima formation was compared with nonradioactive stents by histomorphometry after 1, 4, and 12 weeks. Apoptosis was detected using the terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) assay method and transmission electron microscopy. Results: At an early follow‐up of 1 week after stent implantation, no changes in neointimal apoptosis were found. The 32P stents at activities of 6 μCi, but not of 0.5 μCi, reduced neointimal crosssectional areas and cell numbers compared with control stents after 4 and 12 weeks. Apoptosis in the neointima increased after 4 weeks and was substantially elevated 12 weeks after implantation of 6 μCi 32P stents compared with 0.5 μCi and control stents (16% vs 6% and 3%, P < 0.01 for 6 vs 0.5 μCi and control stents, respectively). Conclusions: In this study, a dose dependent decrease in neointimal thickening and cell density within 32P beta‐particle emitting stents was associated with an increased frequency of apoptosis. This increase in apoptosis occurred late in the time course of vascular healing after the implantation of 32P beta‐particle emitting stents. Apoptosis seems to be involved in the mechanisms by which stent‐based vascular irradiation reduces neointimal hyperplasia.
Transseptal Puncture for Transcatheter Closure of an Eccentric Atrial Septal Defect
Authors: HÖPP HANS W. , BABIC UROS U. , DEUTSCH HANS
Published: June 2007

The feasibility of transcatheter closure of atrial septal defects depends mainly on their morphology. A case is presented illustrating successful closure of a defect with inadequate anterior rim using transseptal puncture of the abundant residual septum. The Atrial Septal Defect Occlusion System (ASDOS) umbrellas could be placed at the center of the septum occluding the defect completely.
Experience with a Portable Digital C‐Arm System for Cardiac Catheterization and Intervention
Authors: SULLEBARGER J. THOMPSON , MAZION DOROTHY , COUREY MICHAEL , SAYAD DANY , SIDDIQUE MAQSOOD , FONTANET HECTOR , MATAR FADI , CINTRON GUILLERMO
Published: June 2007

Recently, portable C‐arm systems have been developed for cardiac studies. While these systems have been used at a number of centers on a small scale for procedures in the operating room, emergency room, or intensive care unit, there are no published data on the performance of the system under more demanding circumstances. Theoretically, a reliable portable C‐arm system could provide a low‐cost alternative to a fixed system in centers with limited resources, such as in developing countries. To test whether a portable C‐arm system could substitute for a permanent laboratory for cardiac catheterization and interventional procedures, we used a C‐arm system as our sole catheterization laboratory for a period of 3 months. The system's performance was compared to a comparable time period using a fixed catheterization laboratory system. The portable system was used to perform 222 procedures (36 interventional and 186 diagnostic), as compared to 236 procedures (30 interventional and 206 diagnostic) with the fixed lab during a comparable time period the preceding year. Although the image quality of the portable system was not as good as with the fixed laboratory, all procedures were performed successfully, with no difference in fluoroscopic time, radiation exposure to the patient, procedure related complications, or clinical restenosis at 1 year. However, radiation exposure to staff was greater, possibly due to the lack of shielding in the temporary lab and the need for the technician to remain close to the unit to set up views. Our results suggest that a portable C‐arm system, while subject to some limitations, can perform as a general catheterization laboratory for diagnostic and interventional procedures.
Primary Stenting of Infrarenal Abdominal Aortic Stenoses: A Report of Seven Cases and Review of the Literature
Authors: AL‐MUBARAK NADIM , LIU MING W. , DEAN LARRY S. , AL‐SAIF SHUKRI M. , AL‐SHAIBI KHALID F. , TYER SIRAM S. , ROUBIN GARY S.
Published: June 2007

Surgical revascularization for severe atherosclerotic stenoses of the infrarenal abdominal aorta is associated with increased morbidity and mortality. We present our experience with percutaneous stenting as a less invasive treatment alternative in seven consecutive patients with the disease (six females, mean age: 63 ± 5). Technical success was achieved in all patients with reduction of the mean percent stenosis from 85 ± 3% down to 13 ± 2%. A total of seven stents were used; 5 Wallstents and 2 Palmaz stents. No immediate complications were observed. One patient developed left leg ischemia due to worsening of a preexisting left iliac lesion a day after the procedure and was successfully stented. All patients were asymptomatic at follow‐up (mean: 27 ± 3 months). The mean ABI was 0.91 ± 0.12 and 0.94 ± 0.15 on the right and left sides, respectively. These results suggest that stenting of focal infrarenal abdominal stenoses is effective and associated with favorable late outcome