bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalous origin of the left circumflex coronary artery from the right aortic sinus: A familial clustering
Authors: Rowe Lew , Carmody Thomas James , Askenazi Joseph
Published: March 2007

Origin of the left circumflex coronary artery from the right sinus of Valsalva or the right coronary artery is a well‐described anomaly. We report 3 cases which suggest a familial association of this anomaly. The familial clustering that we report has not been previously demonstrated. © 1993 Wiley‐Liss, Inc.
Conservative management of guidewire coronary artery perforation with pericardial effusion during angioplasty for acute inferior myocardial infarction
Authors: Flynn Michael S. , Aguirre Frank V. , Donohue Thomas J. , Bach Richard G. , Caracciolo Eugene A. , Kern Morton J.
Published: March 2007

A wire perforation of a totally occluded right coronary artery was treated successfully with prolonged balloon inflation. This non‐surgical management is preferred if physiologic and anatomic conditions are suitable. © 1993 Wiley‐Liss, Inc.
Internal balloon tamponade: A non‐surgical method for removal of accidentally placed sheaths from the subclavian artery
Authors: van Dijk René B. , Heijer Peter Den , Muinck Ebo De , Lie K. I.
Published: March 2007

One of the possible complications of subclavian vein puncture is accidental puncture of the subclavian artery. If this is not noted immediately after the puncture, insertion of a large bore sheath in the subclavian artery is likely to follow. We describe our experience with a new method that enables successful and safe removal of such sheaths without notable blood loss, in three patients. © 1993 Wiley‐Liss, Inc.
Application of intracoronary flow velocity for detection and management of ostial saphenous vein graft lesions
Authors: Kern Morton J. , Flynn Michael S. , Aguirre Frank V. , Donohue Thomas J. , Bach Richard G. , Caracciolo Eugene A.
Published: March 2007

Ostial lesions of saphenous vein grafts can be difficult to assess by angiography. A physiologic approach to the selection and recanalization of ostial lesions in saphenous vein grafts may be advantageous to overcome limitations of angiography. To assist in identifying favorable physiology and facilitate procedural decision making, the use of coronary flow velocity measurements with a Doppler‐tipped 0.018‐inch angioplasty flowire in three particularly difficult patients with varying types of saphenous vein graft aorto‐ostial narrowings is reported.© 1993 Wiiey‐Liss, Inc.
Holmium:Yag laser‐assisted coronary angioplasty with multifiber delivery catheters
Authors: White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Mesa Juan E. , Murgo Joseph P.
Published: March 2007

Mid‐infrared lasers are attractive for coronary angioplasty based upon their excellent fiberoptic transmission and enhanced tissue absorption. Using a solid‐state, mid‐infrared holmium:YAG laser with prototype multifiber laser delivery catheters, we performed coronary laser angioplasty with or without adjunctive balloon angioplasty or directional atherectomy in 14 patients with 17 stenoses. Procedural laser success was obtained in 13/14 (93%) patients and 16/17 (94%) lesions; however clinical success was achieved in 9/14 (64%) patients and 12/17 (71%) stenoses. Angiographic restenosis at 4.6 ± 1.6 months was found in 5/8 (63%) patients. We achieved an excellent procedural laser success rate in patients with generally unfavorable angioplasty anatomy. However, our clinical success rate was not different from that expected with conventional angioplasty alone. The holmium laser remains an attractive energy source for laser angioplasty; but as is the case for all coronary laser systems, its utility as a stand‐alone therapy is limited by catheters which create small channels. In this small group, we could demonstrate no clinical benefit for laser‐assisted angioplasty in complex coronary lesions. Our results suggest that a randomized trial comparing laser‐assisted angioplasty and conventional angioplasty be performed to determine the clinical benefits of this more expensive therapy.© 1992 Wlley‐Liss, Inc
Emergency coronary stenting for acute occlusive dissection of the left main coronary artery
Authors: Garcia‐Robles Jose Antonio , Garcia Eulogio , Rico Mariano , Esteban Elena , De Prado Armando Perez , Delcan Juan Luis
Published: March 2007

Catheter‐induced left main coronary artery dissection is a rare but serious complication of diagnostic cardiac angiography. We report the case of a patient with mitral regurgitation and accidental dissection of the left main coronary artery successfully managed with intracoronary stent that allowed emergent surgical revascularization and mitral replacement.© 1993 Wlley‐Liss, Inc
Angina pectoris caused by subclavian coronary steal
Authors: Rashkow Andrew M.
Published: March 2007

A 79‐year‐old white woman underwent coronary bypass graft surgery using a left internal mammary artery graft. The patient represented with chest pains 4 months later. A total occlusion of the left subclavian artery was documented with a coronary subclavian steal. The patient was treated with an axillo‐axillary Gore‐Tex graft. Pathophysiology and therapeutic options of the coronary subclavian steal are discussed.© 1993 Wlley‐Liss, Inc
Diagnosis of left atrial myxoma at routine coronary angiography in an asymptomatic patient
Authors: Hamer Andrew W. , Weeks Philip A.
Published: March 2007

Asymptomatic atrial myxomas are very rare and are usually diagnosed at echocardiography. Abnormal left atrial vascularity was seen as an incidental finding in an asymptomatic patient at coronary angiography. Transesophageal echocardiography revealed a large left atrial mass and a left atrial myxoma was removed at surgery. The patient remains well© 1993 Wlley‐Liss, Inc
Reversibility of the “string sign” of the left internal mammary artery graft
Authors: Shammas Ronny L. , Mehta Prabodh M. , Jolly Stanley R. , Lust Robert M. , Zeri Richard , Spence Paul A.
Published: March 2007

We report a case that showed reversibility of a generalized narrowing of the left internal mammary graft in response to interruption of collateral flow to the distal vessel supplied by the graft.
© 1993 Wlley‐Liss, Inc
Optimizing surgical backup for multiple simultaneous percutaneous transluminal coronary angioplasty procedures
Authors: AvendañO Amilcar , Vaughn William , Reece Barbara , Ferguson James J.
Published: March 2007

At busy interventional centers, it may be difficult to coordinate surgical backup for multiple simultaneous PTCA procedures. We sought to determine the actual risk of two simultaneous cases requiring surgery, and to identify a group in which multiple simultaneous PTCA procedures could be performed at low risk.

We prospectively applied the ACC/AHA A/B/C lesion classification system and an empiric low/medium/high risk classification (based on patients' overall clinical picture) to 1,128 PTCA procedures over a 9 month period; 22 of these patients (1.9%) went directly from the catheterization laboratory to emergency CABG. The incidence of emergency CABG by groups was A‐low 1/166, A‐medium 1/71, A‐high 0/22, B‐low 1/116, B‐medium 10/481, B‐high 2/52, C‐low 2/47, C‐medium 3/88, and C‐high 2/85.

The patients were divided into two groups: minimal risk (A + B‐low: 3/375 or 0.8%) and increased risk (B‐med/high + C: 19/753 or 2.5%). The difference between the groups was significant using chi square with an α < 0.05. The risk of two cases requiring surgery at the same time was calculated as a function of the number of simultaneous PTCA procedures performed. Six or fewer minimal risk PTCA, one increased risk plus up to three minimal risk, and a maximum of two increased risk cases were found to have a risk of <0.001.

We conclude that it is possible to identify a group of patients with minimal risk, in whom multiple simultaneous procedures can be performed with a negligible probability of two cases requiring surgery at the same time.

Single surgical backup for multiple simultaneous increased risk cases is associated with a finite degree of risk. Some form of risk assessment should be incorporated into institutional algorithms for allocating surgical backup in the setting of multiple simultaneous PTCA procedures.
© 1993 Wlley‐Liss, Inc
Technique for shortening angioplasty guide catheter length when therapeutic catheter fails to reach target stenosis
Authors: Stratienko Alexander A. , Ginsberg Robert , Schatz Richard A. , Teirstein Paul S.
Published: March 2007

Occasionally, the usable length of a balloon angioplasty or other therapeutic catheter is insufficient to reach the target stenosis. We describe a technique of shortening the guide catheter from the proximal end in vivo without removing the coronary guidewire. This permits greater projection of the therapeutic catheter to reach distal stenoses.© 1993 Wlley‐Liss, Inc
Directional atherectomy with the omnicath™: A unique new catheter system
Authors: Mazur Wojciech , Ali Nadir M. , Rodgers George P. , Schulz Daryl G. , French Brent A. , Raizner Albert E.
Published: March 2007

Omnicath™ is a directional atherectomy catheter that employs deflecting nontraumatizing wires to anchor the cutting window at the atherectomy site. This anchoring system regulates the depth of cut and provides directional control and distal perfusion. The system continuously removes debris through a suction port from the operative site. To demonstrate the performance of the device, the Omnicath™ was tested in the external iliac arteries of ten atherosclerotic Hanford miniature swine in which concentric and eccentric lesions were induced. Five animals were sacrificed 3 days after atherectomy; the remaining five animals were sacrificed 6 weeks after the procedure. The acute histology demonstrates depth of cuts varying from partial plaque removal to near full thickness removal of the arterial wall. Histologic sections of the 6 week follow‐up group demonstrated minimal healing response. The anchoring wires did not induce either acute injury or neointimal proliferation in the 6 week follow‐up period. In conclusion, the Omnicath™ permits effective and safe atherectomy in this investigative model.
Coronary stenting with a new ultra‐short balloon expandable device: Early and late animal results
Authors: Anwar Azam , Stertzer Simon H. , Hidalgo Benito O. , Fuente Luis De La , Morales Maria C. , Fischer Edmundo I. C. , Shaw Richard E. , Murphy Mary C. , Myler Richard K.
Published: March 2007

The early and late effects of a new balloon‐expandable coronary stent (Boneau II) were studied in 16 adult mongrel dogs. Thirty‐three balloon‐expandable stents were deployed using standard transfemoral coronary angioplasty technique. Single stents were placed in eight dogs and multiple (two to four) stents were placed in eight dogs. Intravenous heparin (3,000 units) was administered at the beginning of the procedure. Aspirin, dipyridamole, dextran, and warfarin were not administered before or after the procedure. All stent deployments were successful. Angiographic or pathologic examinations were performed within 24 hr of deployment on two of the dogs, at 2 weeks on two of the dogs, at 2 months on three of the dogs, at 6 months on six of the dogs, and at 1 year on three of the dogs. All successfully deployed stents were noted to be widely patent. There was no evidence of side‐branch vessel occlusion. There was no evidence of acute or late vessel thrombosis. Histologic examination at 2 months showed a mean intimal thickness of 153 μm.

The stainless steel Boneau II coronary stent is relatively short and easily deployed. This balloon‐expandable coronary stent was successfully deployed in normal canine arteries without the use of anticoagulation or antiplatelet therapy before or after the procedure. The Boneau II intracoronary stent has a very low thrombogenic potential in dogs.
Lupus anticoagulant: A potential risk factor for complication following percutaneous transluminal coronary angioplasty
Authors: Anglin Peter , Strauss Bradley H. , Brandwein J. M. , Watson K. Randall
Published: March 2007

A patient is described with antiphospholipid antibodies who died approximately 24 hr after an uncomplicated balloon angioplasty. Since the literature suggests a relationship between the presence of antiphospholipid antibodies and thromboses, we suggest that these antibodies may be a risk factor for abrupt closure after percutaneous transluminal coronary angioplasty.
Spontaneous arterial embolization after thrombolytic therapy for acute myocardial infarction: The role of transesophageal echocardiography
Authors: Karalis Dean G. , Kaulback Kurt W. , Ross John J. , Uricchio Francis J. , Chandrasekaran Krishnaswamy
Published: March 2007

Arterial embolization from thrombolytic therapy for acute myocardial infarction is rare. We report two cases of spontaneous arterial embolization following the use of tissue plasminogen activator for acute myocardial infarction. Transesophageal echocardiography was able to identify the source of embolism as mobile atherosclerotic debris within the thoracic aorta. This information was of value in the management of these patients, in that femoral catheterization which could have precipitated further embolization was avoided.
Right coronary ostial atherectomy: A really close shave
Authors: Dulas Daniel D. , Davis Thomas J. , Benton Steven L. , Henry Timothy D.
Published: March 2007

Percutaneous transluminal coronary balloon angioplasty (PTCA) has had limited success with higher complication and restenosis rates in aorto‐ostial lesions. Directional coronary atherectomy (DCA) has been advocated as an alternative to PTCA in such lesions. In this report, we describe a potential complication of DCA in right coronary ostial lesions.
Local intramural drug delivery using an infusion balloon following angioplasty in normal and atherosclerotic vessels
Authors: Rasheed Qaiser , Cacchione Joseph G. , Berry James , Richards Fraser , Bryant Lori , Strony John , Enger Christine , Hodgson John Mc B.
Published: March 2007

Local intramural delivery of various pharmacologic agents following angioplasty has been proposed as a means of reducing restenosis. This study tested whether local intramural delivery of aqueous solutions using an infusion balloon could be accomplished safely in normal vessels and whether such infusion was safe following standard angioplasty in diseased vessels. Infusion of aqueous agents into normal canine arteries had no adverse effect. Infusion of several aqueous agents (≤4 cc at 4 atm) into diseased swine iliac arteries following balloon angioplasty did not worsen existing or create new dissections. Histologically, infusion treated vessels did not differ in either model from vessels treated with angioplasty alone. We conclude that local intramural drug infusion does not create new, or worsen existing, dissections produced during standard balloon angioplasty in diseased vessels.
Heterotopic heart transplantation: catheterization, endomyocardial biopsy, and coronary angiography of the donor heart
Authors: Lowry Richard W. , Bitar Jamil N. , Carter Grinstead W. , Young James B. , Noon George P. , Vardan Sandeep , Cocanougher Beth , Kleiman Neal S.
Published: March 2007

Follow‐up after heart transplantation presently requires invasive techniques to assess graft viability and function. As the heterotopic transplant technique assumes a more important therapeutic role for patients not eligible for an orthotopic allograft, an understanding of the inherent challenges associated with management of these patients is mandatory to optimize patient care. Heterotopic transplant technique was used in 19 of 135 (14%) consecutive heart transplant procedures over a 41 month period. Invasive diagnostic procedures performed in follow‐up revealed (1) adequate tissue for histologic evaluation in 140/158 (89%) biopsy procedures, (2) successful pulmonary wedge pressure measurements in 142/158 (90%) right heart catheterizations, and (3) successful coronary arteriography in 18 patients undergoing angiography (both vessels in 12 and one vessel in six patients). Thus, biopsy and surveillance procedures are feasible and productive in patients who have undergone heterotopic heart transplantation.

Background: Although heterotopic heart transplantation has become an increasingly utilized therapy for some patients with heart failure, there are no guidelines for routine biopsy and angiographic techniques in these patients. The objective of this study was to determine the feasibility of angiographic and endomyocardial biopsy procedures in heterotopic heart transplant recipients.

Methods: The complete experience with heterotopic heart transplant recipients at Baylor College of Medicine and The Methodist Hospital over a 41 month period including endomyocardial biopsy, right heart catheterization, and selective coronary arteriography results were analyzed.

Results: Eighteen patients underwent 310 procedures without significant complications. Of 158 biopsy procedures, 140 (89%) yielded tissue adequate for histologic evaluation. Right heart pressures were obtained in almost all patients undergoing right heart catheterization. Pulmonary wedge pressures were obtained in 137 (90%). A rapid decrease in right heart pressures was noted following transplant; however, a gradual but significant rise in mean arterial pressure occurred. Eighteen selective coronary arteriogram procedures were performed; 12 (66%) resulted in successful cannulation of both coronary arteries. Of 12 patients followed for at least 1 year, five (40%) have developed evidence of allograft arteriopathy. The 1 and 2 year survival rates were 67% and 53%, respectively.

Conclusions: Invasive diagnostic techniques can be performed safely and reliably and should not preclude the use of heterotopic heart transplantation in selected patients who are otherwise unsuitable for orthotopic transplantation. © 1994 Wiley‐Liss,Inc..
Bedside monitoring of heparin therapy: comparison of activated clotting time to activated partial thromboplastin time
Authors: Reiner Jonathan S. , Coyne Karin S. , Lundergan Conor F. , Ross Allan M.
Published: March 2007

Heparin anticoagulation is utilized during and after interventional cardiac catheterization procedures to reduce the risk of acute thrombotic coronary artery occlusion. The short half‐life of heparin, the importance of maintaining therapeutic anticoagulation, and the time delay inherent in the processing and retrieval of the activated partial thromboplastin time (aPTT) by the hospital laboratory has generated interest in point‐of‐care heparin monitoring. The activated clotting time (ACT), the aPTT as assessed by both a new portable device, as well as the hospital laboratory, and heparin levels (H) were obtained from the same sample of blood in 100 patients receiving intravenous heparin. There was an excellent correlation between the aPTT determined at the bedside and by the hospital laboratory (r = .89). The ACT did not correlate well with either the laboratory or bedside aPTT (r = .63, .68 respectively). In the sub‐therapeutic and therapeutic range, there was essentially no correlation between ACT and H. Only ACT values > 225 sec were predictive of therapeutic or supra‐therapeutic aPTTs. ACT values < 225 sec, however, were not useful in predicting degree of anticoagulation. In situations in which the maintenance of therapeutic anticoagulation is critical as well as those in which the determination of lack of anticoagulation is required, the bedside determination of aPTT appears to be a useful tool © 1994 Wiley‐Liss,Inc...
Endoluminal stenting of narrowed saphenous vein grafts: long‐term clinical and angiographic follow‐up
Authors: Eeckhout Eric , Goy Jean‐Jacques , Stauffer Jean‐Christophe , Vogt Pierre , Kappenberger Lukas
Published: March 2007

From April 1986 through April 1993, 58 intracoronary stents (41 Wall and 17 Wiktor stents) were implanted for the treatment of saphenous vein graft stenosis in 40 symptomatic patients. The indication was a primary stenosis in 44 and restenosis in 14 procedures. In‐hospital complications were subacute stent thrombosis (2%), myocardial infarction (2%), and emergency coronary artery bypass grafting (CABG) (2%). Complications during a mean follow‐up period of 42±27 months were restenosis (35% by patient, 33% by lesion), myocardial infarction (12%), late bypass grafting (12%), and death (7%). On quantitative coronary angiographic analysis, the mean minimal luminal diameter (and its confidence interval) increased from 1.3 mm (1.1–1.5 mm, preprocedure) to 2.9 mm (2.7–3.1 mm, postprocedure) and 2.2 mm (2.0–2.5 mm, 6 months follow‐up, 95% angiographic follow‐up). Progression of the underlying coronary artery disease and restenosis were the main reasons for a continual decline of the proportion without cardiac event on a Kaplan‐Meier estimate. Restenosis occurred in one‐third of cases beyond the first 6 months of follow‐up. A relative risk ratio analysis for restenosis, performed on 14 variables, disclosed an increased risk for the following variables: (1) stenting of the proximal, distal or anastomosis part of the vein graft (relative risk 2.41, confidence interval: 1.28–3.59), (2) the implantation of stents <4.5 mm (2.59, 1.18–4.00), and (3) stenting of a redo–CABG vein graft (2.37, 1.17–3.58). Saphenous vein graft stenting seems to be characterized by excellent immediate clinical and angiographic results; in particular, stent thrombosis is rare. In this study, it appears that restenosis rates are lower than after conventional balloon angioplasty, but several procedural factors are related to an increased restenosis risk. Despite a lasting success in the majority of stented lesions, the estimated proportion without cardiac event is low at 5 years follow‐up. Progression of the underlying coronary artery disease, a non‐procedure‐related event, constitutes the major limitation of saphenous vein graft stenting. © 1994 Wiley‐Liss,Inc..
Coronary flow velocity during coronary angioplasty in regions of myocardial infarction
Authors: Moore Joseph A. , Kern Morton J.
Published: March 2007

In patients undergoing angioplasty for angina after myocardial infarction, patterns of post‐stenotic coronary blood flow velocity depend not only on satisfactory dilation of the flow‐limiting lesion, but also on the vasoregulatory capacity of infarcted myocardium. The case examples demonstrate both normal and persistently abnormal flow velocity patterns following successful coronary angioplasty for post‐infarction ischemia. Recognition of collateral flow patterns, easily available using the Doppler angioplasty guidewire, may provide valuable information predicting the viability of post‐infarcted myocardium and the resolution of abnormal distal coronary flow patterns. © 1994 Wiley‐Liss,Inc..
Transcatheter treatment of angina after coronary surgery due to concomitant internal mammary steal and right coronary artery stenosis: a need for staging
Authors: Missault Luc , Taeymans Yves , Caes Frank , Nooten Guido Van , Belleghem Yves Van , Clement Denis
Published: March 2007

Unligated side branches of the internal mammary artery used as a conduit in bypass surgery can be responsible for a flow steal phenomenon, causing recurrent angina. In this report we describe such a case, which was treated with a transcatheter embolization technique using coils as an alternative to surgery. However, heparin administration for simultaneous balloon dilatation of another lesion delayed successful embolization. Whenever balloon dilatation and embolization have to be performed on the same patient, both procedures should be staged to avoid heparin administration during and after the embolization procedure. © 1994 Wiley‐Liss,Inc..
Efficacy and safety of using perfusion dilatation catheter as initial balloon in coronary angioplasty
Authors: Waksman Ron , Ghazzal Ziyad M. B. , Scott Neal A. , Douglas John S. , King Spencer B.
Published: March 2007

The efficacy and safety in using a new low‐profile perfusion balloon catheter (PBC) as the initial balloon in percutaneous coronary angioplasty (PTCA) was assessed retrospectively in 61 patients: 43 males, mean age 62 ± 12 years. Thirty‐three patients (54%) had unstable angina. PTCA was performed using an improved PBC in the following vessels: LAD 40%; CX 21%; RCA 24%. Lesion morphology was: Type A 21%; Type B1 18%; Type B2 40%; Type C 21%. Mean artery size was 3.01 ± 0.53 mm. Mean PBC size was 3.14 ± 0.45 mm. The mean number of inflations used was 2.85 ± 2.0. The mean longest inflation was 415 ± 213 sec and the total inflation time was 663 ± 342 sec to a mean maximum pressure atmosphere of 7.85 ± 2.0 bars. The number of balloons used per procedure was 1.2 ± 0.44. In 50 patients (82%) only one balloon was used during the PTCA. PTCA was successful (<50% diameter stenosis without major complications) in 60 patients (98.4%). Mean diameter stenosis at baseline was 82 ± 9.5% and post‐angioplasty 13 ± 10.6%. A mild intimal tear occurred in 6 patients (9.8%). A stent was implanted in 3 patients (4.9%) due to severe dissection. In hospital reocclusion occurred in one patient (1.6%). There were no deaths or emergency bypass surgery. A low profile PBC is safe and effective as an initial balloon in PTCA. It may reduce the number of balloons used and inflations per procedure. © 1994 Wiley‐Liss,Inc
Circumferential balloon rupture and catheter fracture due to entrapment in a calcified coronary stenosis
Authors: Carell Edgar S. , Schroth George , Ali Abdul
Published: March 2007

We report a case of coronary angioplasty balloon rupture and catheter fracture within a calcified lesion, requiring emergency coronary bypass surgery. The entrapped catheter could not be removed at surgery. This case re‐emphasizes the hazards associated with angioplasty of calcified lesions. © 1994 Wiley‐Liss,Inc..
Diffuse spasm of a free gastroepiploic artery graft during percutaneous balloon angioplasty
Authors: Hara Kazuhiro , Kashida Mitsuo , Tamura Tsutomu , Saeki Fumihiko , Ikari Yuji , Suma Hisayoshi
Published: March 2007

Percutaneous transluminal balloon dilation of an 8‐month‐old free graft of the gastroepiploic artery was followed by diffuse and profound graft spasm. Because free arterial grafts are more prone to spasm, suitable precautions, such as administration of calcium channel antagonists, should be taken before attempting any interventions on these vessels. © Wiley‐Liss, Inc.
Extension of a spontaneous coronary artery dissection due to thrombolytic therapy
Authors: Buys Eugene M. , Suttorp Maarten J. , Morshuis Wim J. , Plokker H. W. Thijs
Published: March 2007

We describe a case of spontaneous coronary artery dissection in a 38‐year‐old woman presenting with anterior myocardial infarction who was initially treated with thrombolysis. During the administration of thrombolytics the clinical symptoms and the electrocardiogram (ECG) deteriorated. Coronary angiography revealed a major dissection in the proximal left descending coronary artery. A spontaneous dissection was hypothesized to have extended by thrombolytic‐induced bleeding into the dissected vessel wall. Therefore, we advocate that, especially in young female patients presenting with an acute myocardial infarction and without cardiac risk factors, direct coronary angiography be considered, rather than thrombolytic therapy, in order to decide for the optimal therapeutic strategy. © Wiley‐Liss, Inc.
In vitro study of a radiofrequency guidewire aimed at recanalization of totally occluded peripheral arteries
Authors: Melnik Ivan , Dupouy Patrick , Kvasnicka Jan , Bhatia Anil , Geschwind Herbert J.
Published: March 2007

A novel radiofrequency ablative system (40 msec‐train pulses with twenty 200 msecpulses at the carrier frequency of 750 KHz and 1 Hz repetition rate) aimed at recanalizing totally occluded peripheral arteries was investigated by means of in vitro tissue ablation from human postmorten arterial wall samples. The samples were submitted to irradiation with a guidewire 150 cm long, maximum diameter of ceramic tip 0.033 inch positioned perpendicular to the tissue surface in saline, contrast medium or blood using varying generator power. Ablation efficacy was determined as the depth of vaporization per pulse delivered. Electrical current for the train duration was measured as voltage at the 1 ohm‐resistor. In saline, the ablation efficacy increased from 8 to 65 μm/pulse with generator power increasing from 11 W to 27.5 W. There was no significant difference in the ablation efficacy between saline and blood. In contrast medium, the ablation efficacy was significantly lower. For the same generator power, the electrical current varied during the ablation procedure from 1.3 ± 0.2 A at the beginning of the procedure to 1.1 ± 0.2 A after the first pulses and to 2.0 A before artery wall perforation occurred. Neither tissue ablation nor current variations were observed when radiofrequency energy was emitted on calcified tissue. The diameter of craters was 0.89 ± 0.1 mm (range: 0.85–0.96 mm). No major thermal injury such as carbonization or charring was observed. Thus. (1) radiofrequency energy emitted through a guidewire is reliable and effective for the ablation of arterial tissue; (2) the depth of penetration is related to the generator power; (3) the ablation efficacy is greater in saline and blood than in contrast medium; (4) the system is not effective in highly calcified tissue; and (5) the procedure may be monitored by electrical current measurements. © Wiley‐Liss, Inc.
Mechanical coronary artery shortening with vessel wall deformity during directional coronary atherectomy: First reported case involving the left anterior descending artery
Authors: Shea Patrick J.
Published: March 2007

Coronary spasm, dissection, thrombosis, and mechanical coronary artery obstruction due to vessel shortening and deformity resulting from kinking, invagination, or collapse in an accordion‐like fashion are recognized sources of iatrogenic obstruction during PTCA. Rapid recognition is required to initiate appropriate therapy. Described is the first reported case of mechanical obstruction involving the left anterior descending artery. © Wiley‐Liss, Inc.
Initial clinical application of a novel coronary angioplasty guide catheter exchange device
Authors: Teirstein Paul S.
Published: March 2007

The initial clinical experience with a novel device designed to facilitate guide catheter exchange during coronary angioplasty while maintaining a secure guidewire position (Marathon Relay, Baxter Interventional Cardiology, Irvine, CA) is described. Over a 7‐month period, 23 guide catheter exchanges were attempted during 20 procedures. The angioplasty procedure involved the use of newer devices in 65% of attempts with coronary stent deployment in 50% of attempts. In the majority (57%) of cases, exchanges were performed to allow improved guide catheter support. The exchange procedure was successful in 91% of attempts. Ultimate procedural success was achieved in 95% of patients with no complications. In this early experience, this device was found to be safe and effectively facilitated guide catheter exchange. © Wiley‐Liss, Inc.
Volumetric intracoronary ultrasound: Methods and validation
Authors: Dhawale Paritosh J. , Wilson David L. , Hodgson John McB.
Published: March 2007

Intracoronary ultrasound (ICUS) not only allows visualization of the vessel lumen, it gives a unique view of the transmural components of the artery wall. Analysis of lumen and plaque volume is necessary for studying atherosclerotic disease progression or regression and the mechanisms of therapeutic coronary interventions. A real‐time, ICUS pullback data acquisition scheme was developed to acquire calibrated, cardiac‐gated volumetric image data sets. A semiautomated border detection scheme was implemented using dynamic programming. In phantoms, estimated area profiles were very reproducible as measured by the root‐mean‐square from the mean (3.8‐5.9%). In phantom volume estimates, improved reproducibility (standard deviation = 1.2‐3.6%) was obtained as positive and negative errors in area profiles were averaged out. Phantom volumes were also accurate when compared to true water displacement volume. The mean error ranged from −2.59 to −8.94%. When compared to quantitative single and biplane angiographic analysis, ICUS volumetric estimates tended to be superior to single plane analysis (error −5.06 ± 2.48% vs −9.96 ± 8.01%), but similar to optimal biplane analysis (error −5.06 ± 2.48% vs −6.34 ± 3.08%). In vivo reproducibility was assessed by performing multiple cardiac‐gated pull‐backs through experimentally induced stenosis. Over the length of the stenosis, excellent reproducibility of area profiles (± 5.9%) and volumes (± 1.9%) was obtained for cardiac‐gated acquisitions. We conclude that volumetric ICUS provides accurate and reproducible estimates of lumen volume. Thus this technique may be of use in clinical trials where changes lumen volumes and vessel area profiles are of interest. © Wiley‐Liss, Inc.
Development of left atrial thrombus following attempted percutaneous mitral valvuloplasty
Authors: Lee Kamthorn S. , Tuzcu E. Murat , Elliott John M. , Griffin Brian P.
Published: March 2007

In this report, we describe two cases of attempted mitral valvuloplasty using an Inoue balloon in which left atrial thrombus was not present before transseptal puncture but developed within minutes of the puncture in one, and within 1 mo in the other, despite systemic anticoagulation. © Wiley‐Liss, Inc.
Right‐to‐left shunt following repair of partial anomalous pulmonary venous connection: A novel use of the Rashkind double‐umbrella occlusion device
Authors: Harrison D. A. , Benson L. N. , Cusimano R. J. , McLaughlin P. R.
Published: March 2007

A patient with partial anomalous pulmonary venous connection complicated by postoperative occlusion of the distal superior vena cava and a baffle leak causing right‐to‐left shunt is described. Surgery was avoided by balloon dilation and stenting of the superior vena cava. The baffle leak was closed with a Rashkind double‐umbrella device. © Wiley‐Liss, Inc.
Cardiac angiosarcoma arising in a coronary artery: Angiographic and pathologic findings
Authors: Rudoff John , Slavin Richard E.
Published: March 2007

We discuss a unique case of an angiosarcoma which arose in an atherosclerotic coronary artery. It was widely metastatic. We describe the angiographic findings and their differential diagnosis, and briefly discuss this relatively common cardiac malignancy.
Primary stent deployment in occlusive subclavian artery disease
Authors: Kumar Krishna , Dorros Gerald , Bates Mark C. , Palmer Leslie , Mathiak Lynne , Dufek Christine
Published: March 2007

Primary (without antecedent balloon dilation) Palmaz™ stent implantation was successfully performed in 27 consecutive patients entering with 31 obstructed subclavian arteries. Stents (n = 50) were successfully deployed, using the brachial (n = 7), femoral (n = 16), or combined (n=8) approach, to revascularize 31 subclavian vessels [8 occluded (26%); 23 stenotic (74%)], using a 6 or 7.5 French delivery system. The indications for intervention were arm claudication in 8 patients (30%), subclavian steal syndrome in 11 patients (41%), angina pectoris secondary to impaired blood flow to the left internal mammary artery coronary bypass in 6 patients (22%), and recanalization of a left subclavian occlusion to permit central arterial access and performance of a second interventional procedure 2 patients (7%). The percent diameter stenosis improved from 85 f 12% to 6 f 7% (P<0.001); and, the peak and mean translesion gradients decreased, respectively, from 56 f 35 mm Hg to 3 f 4 mm Hg (P<0.01), and 29 f 18 mm Hg to 2 k 2 mm Hg (P<0.01). Procedural complications encountered were one stent dislodgement with migration into and uneventful deployment within the right external iliac artery, and two brachial artery repairs. No acute vessel closures, deaths, myocardial infarctions, cerebrovascular accidents, transient ischemic attacks, or need for transfusions occurred. Therefore, primary subclavian artery stent deployment can be performed using low‐profile sheath systems with excellent success (100%), resulting in immediate restoration of pulsatile flow, and few complications. The incidence of lesion recurrence remains for follow‐up studies.
Catheter‐induced “accordion effect” in tortuous right external iliac artery during peripheral angiography
Authors: Joseph Davees , Idris Mohammed
Published: March 2007

Mechanical distortion of tortuous coronary arteries mimicking spasm or dissection during percutaneous transluminal coronary angioplasty due to balloon guidewire systems has previously been reported. This case reports a similar phenomenon in the peripheral vascular system induced by a diagnostic catheter. Recognition of this pseudo lesion may help to avoid complications and unnecessary intervention.
Usefulness of interlocking detachable coil for embolization of the major aorto‐pulmonary collateral artery: A case report
Authors: Kawata Tetsuji , Hasegawa Junichi , Yoshida Yoshitsugu , Kawachi Kanji , Kitamura Soichiro
Published: March 2007

A 5‐yr‐old male had undergone a right‐modified Blalock‐Taussig shunt operation at the age of 1 mo for stenotic patent ductus arteriosus and pulmonary atresia with ventricular septal defect. Before a corrective operation, the angiogram revealed one large major aorto‐pulmonary collateral artery from the descending aorta to the right upper lung. Embolization of the major aortopulmonary collateral artery was successfully performed using interlocking detachable coils. This is the first reported case of embolization of the major aorto‐pulmonary collateral artery using this device.
Development of a new technique for reducing pressure pulse generation during 308‐nm excimer laser coronary angioplasty
Authors: Tcheng James E. , Wells Lisa D. , Phillips Harry R. , Deckelbaum Lawrence I. , Golobic Robert A.
Published: March 2007

Despite expectations that excimer laser ablation would result in a low incidence of coronary dissection, studies have documented a 15–20% incidence of dissection (including a 4–6% incidence of clinically significant dissection) during excimer interventions. This investigation sought to determine if pressure pulses produced by the exposure of fluid phase media (blood and contrast) to 308‐nm excimer radiation might contribute to unto‐ward outcomes. Pressure pulses generated in these media were quantitated to be > 100 atm. In vitro ablation of porcine aorta in the presence of blood or contrast resulted in tissue dissection, while ablation in pure crystalloid did not. Next, a “flush and bathe” technique designed to replace all blood and contrast with crystalloid was applied to a pilot population of 57 consecutive patients. There were no rhythm disturbances or laserrelated clinically significant dissections in this group, and the clinical success rate was 95%. In summary, this report quantitates a potential etiology for excimer dissection and suggests that replacement of blood and contrast with crystalloid might improve procedural and clinical success rates.
Balloon dilation of critical valvar pulmonary stenosis in the first month of life
Authors: Colli Anna M. , Perry Stanton B. , Lock James E. , Keane John F.
Published: March 2007

Between 1985 and 1992, 36 consecutive neonates, aged 1–29 days, weight 2.4–5.0 kg, with critical valvar pulmonary stenosis underwent attempted balloon dilation (BD). At catheterization, 30 were on prostaglandin (PGE1) therapy and 20 were intubated. The valve was successfully crossed and dilated in 34/36 (94%), including three with an echocardiographic diagnosis of valvar pulmonary atresia and a right ventricle of adequate size. The valve was first dilated with a 2‐ to 5‐mm balloon and then with serially larger ones (up to 12 mm) to a final balloon/annulus value of 126%. The RV/systemic pressure value fell from 150 ± 32 to 83 ± 30%, O2 saturation rose from 91 ± 6% to 96 ± 4%, and PGE1 was discontinued at the end of the procedure. There were 11 complications (31%) including one early death from sepsis and necrotizing enterocolitis, endocarditis in another, two myocardial perforations, one femoral‐iliac vein tear, and one transient pulse loss.

A repeat BD was carried out in five patients, two of whom subsequently had surgery. At follow‐up (33 ± 23 months), the 31 patients managed by BD alone were well and had echocardiographic gradients of < 30 mm Hg in 90% and pulmonary regurgitation, considered mild in most, in 52%.

In neonates with critical valvar pulmonary stenosis, we believe BD mortality is less than with surgery and is the treatment of choice.
Transvenous coronary arteriography via ventricular septal defect for infants and children with tetralogy of fallot
Authors: Sakamoto Tohru , Suzuki Akio
Published: March 2007

Selective coronary arteriography was performed by the antegrade transvenous technique in 13 cases of young children with tetralogy of Fallot utilizing two specially designed catheters. Right coronary arteriography was successfully performed in all, and left coronary arteriography was successful in the latest four cases. The importance of the catheter design is discussed based on the anatomical characteristics of the anomaly.
Systemic anaphylactoid reactions to lodinated contrast media during cardiac catheterization procedures: Guidelines for prevention, diagnosis, and treatment
Authors: Goss Jerome E. , Chambers Charles E. , Heupler, Jr Frederick A.
Published: March 2007

This report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Anaphylactoid reactions are nonimmune mediated, but histamine release and other mediators produce a clinical presentation indistinguishable from anaphylaxis. In patients with known previous reactions, pretreatment with steroids and diphenhydramine and the use of nonionic contrast media have significantly reduced the potential of recurrent reaction. Minor reactions such as limited urticaria may be watched for progression or treatment with diphenhydramine, whereas more serious reactions such as angioedema or laryngeal edema require airway stability and ephinephrine administration. Shock should be vigorously treated simultaneously with intravenous epinephrine and large volumes of normal saline. If the patient can be stabilized, the study should be completed as histamine, leukotrienes, and other vasoactive products should be relatively depleted.
Stenting with the half (disarticulated) palmaz‐schatz stent
Authors: Mehan Vivek K. , Kaufmann Urs , Urban Philip , Chatelain Pascal , Meier Bernhard
Published: March 2007

A total of 110 half (disarticulated) Palmaz‐Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail‐out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non‐Q wave myocardial infarctions), and one non‐Q wave infarction related to side branch closure.

Stenting with the half Palmaz‐Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.
Emergency endoluminal stenting for abrupt vessel closure following coronary angioplasty: A randomized comparison of the wiktor and palmaz‐schatz stents
Authors: Goy Jean‐Jacques , Eeckhout Eric , Stauffer Jean‐Christophe , Vogt Pierre , Kappenberger Lukas
Published: March 2007

In order to compare the efficacy of two different stent types in case of bailout stenting, 65 patients, with abrupt or threatened vessel closure following coronary angioplasty, were randomly assigned to either Wiktor (Medtronic Inc., Minneapolis, MN, 33 patients) or Palmaz‐Schatz (Johnson & Johnson Interventional, Warren, NJ, 32 patients) stent implantation. Stenting was technically feasible in all except one patient and immediately successful in reverting ischemia and vessel closure in 60 patients (92%). At hospital discharge, complication rates were comparable: early vessel closure, 18% (Wiktor) versus 13% (Palmaz‐Schatz) (P=0.53); any clinical event (such as death, myocardial infarction, and surgical revascularization): 18% (Wiktor) versus 22% (Palmaz‐Schatz) (P=0.71). At 6 months follow‐up, these complication rates remained equal: restenosis, 38% (Wiktor) versus 27% (Palmaz‐Schatz) (P=0.42); any clinical and angiographic (vessel closure and restenosis) event: 45% (Wiktor) and 41% (Palmaz‐Schatz) (P=0.69). Baseline, direct postprocedural, and follow‐up quantitative coronary analysis data were similar, with, however, an exception for the postprocedural residual stenosis [28% (24‐32%) (Wiktor) and 21% (18‐23%) (Palmaz‐Schatz] (means and 95% confidence intervals). In conclusion, despite a discrete postprocedural angiographic benefit observed with the Palmaz‐Schatz stent, the long‐term clinical and angiographic outcome is similar in both treatment groups. The choice whether to implant a Wiktor or Palmaz‐Schatz stent may probably be left to the discretion of the operator and his experience with one particular device.
Percutaneous transradial coronary palmaz‐schatz stent implantation, guided by intravascular ultrasound
Authors: Kiemeneij Ferdinand , Laarman Gert Jan , Slagboom Ton
Published: March 2007

Intravascular ultrasound (IVUS) allows accurate assessment of stent deployment, its use being confined to the use of 8 French (F) guiding catheters. We evaluated the feasibility of combining transradial artery Palmaz‐Schatz stent implantation through 6F guiding catheters with IVUS for assessment of stent diameter after delivery at moderate inflation pressures (10‐12 atmospheres [atm]) with compliant balloons and after high pressure dilatations with balloons of intermediate compliance. In 8 consecutive patients, 12 stents were delivered with Scimed® ExpressTM balloon catheters at 10‐12 atm followed by IVUS (EndoSonics® CathScanner; Visions® FX 3.5F 20 MHz transducer). An ultrasound study was repeated after high pressure dilatations (16‐20 atm) with Schneider® Magical SpeedyTM balloon catheters. The balloon diameters were derived from manufacturer provided specifications. In all patients the transducer could easily be advanced through the guiding catheters. Reference diameter of the stented segment was 3.7 ± 0.5 mm (2.7‐4.5) and the diameter of Scimed® ExpressTM balloons during inflation was 4.0 ± 0.3 mm (3.6‐4.7). Stent diameter was 3.0 ± 0.1 mm (2.8‐3.2) (P < 0.001 compared to the reference and the balloon diameter). The diameter of the Schneide® Magical SpeedyTM balloons at secondary dilatations with 16 ± 3 atm (14‐20) was 4.1 ± 0.4 mm (3.3‐4.5) (P = 0.50 compared to the initial balloon diameter). Final stent diameter was 3.3 ± 0.4 mm (2.9‐4.1) (P = 0.02 compared to the initial stent diameter). All stents were symmetrically deployed and well apposed. No damage to vessel or stents was detected after passage of the transducer. Thus ultrasound guided stenting via 6F guiding catheters is feasible, and high pressure dilatations with balloons of intermediate compliance results in better stent expansion than after 10‐12 atm inflations with compliant balloon catheters.
Sequential implantation of dissimilar tandem stents for long dissections complicating percutaneous transluminal coronary angioplasty
Authors: Sankardas Mullasari Ajit , Garrahy Paul John , McEniery Paul Timothy
Published: March 2007

Acute closure remains a significant complication of percutaneous angioplasty, and coronary artery stenting serves as a useful bail‐out device. We describe two cases of sequential implantation of dissimilar tandem stents, a Gianturco—Roubin (4 × 20mm) stent and a Palmaz‐Schatz (4 × 15mm) stent, for long dissection complicating percutaneous transluminal coronary angioplasty.