01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS.Procedural Factors Associated With Percutaneous Coronary Intervention-Related Ischemic Stroke

Scott J. Hoffman, MD; Helen C. Routledge, MD; Ryan J. Lennon, MS; Mohammad Z. Mustafa, MB, ChB; Charanjit S. Rihal, MD; Bernard J. Gersh, MB, ChB, DPhil; David R. Holmes, Jr, MD; Rajiv Gulati, MD, PhD

Objectives: This study sought to determine whether procedural factors during percutaneous coronary intervention (PCI) are associated with the occurrence of ischemic stroke or transient ischemic attack (PCI-stroke).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Endothelial and Smooth Muscle Cells Dysfunction Distal to Recanalized Chronic Total Coronary Occlusions and the Relationship With the Collateral Connection Grade FREE

Salvatore Brugaletta, MD; Victoria Martin-Yuste, MD; Teresa Padró, PhD; Luis Alvarez-Contreras, MD; Josep Gomez-Lara, MD; Hector M. Garcia-Garcia, MD, PhD; Clarissa Cola, MD; Giovanna Liuzzo, MD, PhD; Monica Masotti, MD, PhD; Filippo Crea, MD, PhD; Lina Badimon, PhD; Patrick W. Serruys, MD, PhD; Manel Sabaté, MD, PhD

Objectives: This study sought to assess the vascular function in patients with chronic total coronary occlusions (CTO) immediately after successful percutaneous recanalization and its relation with the pre-existing collateral circulation.

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Staged Versus One-time Complete Revascularization With Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease Patients Without ST-Elevation Myocardial Infarction

Edward L. Hannan, PhD, Zaza Samadashvili, MD, Gary Walford, MD, Alice K. Jacobs, MD, Nicholas J. Stamato, MD, Ferdinand J. Venditti, MD, David R. Holmes Jr, MD, Samin Sharma, MD and Spencer B. King III, MD

Background—There are evidence-based guidelines for staging of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), but we are not aware of any evidence comparing the strategy of complete revascularization (CR) with PCI in the index admission versus the strategy of staging in a subsequent admission for patients with coronary artery disease without STEMI.

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Functional Assessment of Jailed Side Branches in Coronary Bifurcation Lesions Using Fractional Flow Reserve

Jung-Min Ahn, MD; Jong-Young Lee, MD; Soo-Jin Kang, MD, PhD; Young-Hak Kim, MD, PhD; Hae-Geun Song, MD; Jun-Hyok Oh, MD; Jong Seon Park, MD; Won-Jang Kim, MD; Seung-Whan Lee, MD, PhD; Cheol Whan Lee, MD, PhD; Jae-Joong Kim, MD, PhD; Seong-Wook Park, MD, PhD; Seung-Jung Park, MD, PhD

Objectives: This study was designed to assess the functional significance of side branches after stent implantation in main vessels using fractional flow reserve (FFR).

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Standing Arterial Waves Is NOT Fibromuscular Dysplasia

Aditya M. Sharma, MD and Heather L. Gornik, MD, MHS

We report 2 cases in which patients were misdiagnosed as having fibromuscular dysplasia (FMD) due to the finding of standing arterial waves on lower extremity angiography.

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Medical Device Regulatory Landscape. The Imperative of Finding Balance

Aaron V. Kaplan, MD and David O. Williams, MD

The past 60 years have witnessed fundamental advances in our understanding and treatment of cardiovascular disease, prolonging and improving patients lives. Central to these improvements has been the introduction of medical devices, including mechanical and biological heart valves, heart rhythm devices, and balloon angioplasty and stents. The introduction of these technologies has been dependent on an entrepreneurial medical device sector, coupled with an equally robust infrastructure to clinically develop and evaluate these new technologies. After approval and commercialization, continued study of device performance under real world conditions is crucial to ensure that the clinical potential is being realized.

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Long-Term Comparison of Everolimus- and Sirolimus-Eluting Stents in Patients With Acute Coronary Syndromes

Bindu Kalesan, MSc; Giulio G. Stefanini, MD; Lorenz Räber, MD; Mathieu Schmutz, MD; Sandro Baumgartner, MS; Sarah Hitz, MS; Samuel H. Baldinger, MD; Thomas Pilgrim, MD; Aris Moschovitis, MD; Peter Wenaweser, MD; Lutz Büllesfeld, MD; Ahmed A. Khattab, MD; Bernhard Meier, MD; Peter Jüni, MD; Stephan Windecker, MD

Objectives: The goal of this study was to compare the long-term clinical outcome between everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) in patients with acute coronary syndromes (ACS).

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Stent-Assisted Coil Embolization of a Large Fusiform Aneurysm of Proximal Anterior Descending Artery. Novel Treatment for Coronary Aneurysms

Htut K. Win, MD, Venkateshwar Polsani, MD, Su Min Chang, MD and Neal S. Kleiman, MD

A 37-year-old Asian American man presented with severe stable angina of recent onset over a period of 3 weeks. He was an active policeman, whose only significant past medical history was a prolonged febrile illness with a rash at age 5. Exercise myocardial perfusion stress test was strongly positive with ST depression in inferolateral leads and large reversible perfusion defects in the inferior, inferolateral, and lateral walls of the left ventricle. Cardiac catheterization revealed a large fusiform aneurysm of the proximal left anterior descending (LAD) artery, ectasia of the proximal circumflex artery with 95% narrowing, and an occluded right coronary artery with an occluded proximal aneurysm. (Figure 1).

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Predictors of Periprocedural (Type IVa) Myocardial Infarction, as Assessed by Frequency-Domain Optical Coherence Tomography

Italo Porto, MD, PhD, Luca Di Vito, MD, Francesco Burzotta, MD, PhD, Giampaolo Niccoli, MD, PhD, Carlo Trani, MD, PhD, Antonio M. Leone, MD, PhD, Luigi M. Biasucci, MD, PhD, Rocco Vergallo, MD, Ugo Limbruno, MD and Filippo Crea, MD, FESC

Background—Frequency-domain optical coherence tomography (FD-OCT) is easily able to define both pre- and post-stenting features of the atherosclerotic plaque that can potentially be related to periprocedural complications. We sought to examine which FD-OCT-defined characteristics, assessed both before and after stent deployment, predicted periprocedural (type IVa) myocardial infarction (MI).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. New Insights on Stent Thrombosis. In Praise of Large Nationwide Registries for Rare Cardiovascular Events⁎

Fernando Alfonso, MD, PhD; Jorge Sandoval, MD

Stents represent the default strategy in interventional cardiology (1). In the last decade, drug-eluting stents (DES) have been widely embraced because of their unprecedented ability to drastically inhibit neointimal proliferation. Accordingly, the clinical need for repeat revascularization has been significantly reduced despite the widespread use of coronary interventions in ever increasingly complex clinical and anatomic scenarios. However, the risk of stent thrombosis (ST) remains an issue of serious concern (2). DES have been unable to reduce the incidence of this complication but have changed its temporal pattern of presentation, widening the vulnerable period. Actually, this problem has prevented an even wider penetration of DES (1- 2).

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia. A Case Series

Jacqueline Saw, MD, Rohan Poulter, MD, Anthony Fung, MBBS, David Wood, MD, Jaap Hamburger, MD, PhD and Christopher E. Buller, MD

Young women with acute coronary syndrome (ACS) frequently have nonatherosclerotic coronary artery disease (NACAD) and may be misdiagnosed. Coronary fibromuscular dysplasia (CFMD) commonly is overlooked, as the angiographic appearance is often subtle. Our group previously described CFMD as a diffuse obliterative disease starting abruptly at the mid-distal vessel, involving long segments.1 Spontaneous coronary dissection (SCAD) is another common form of NACAD and may be superimposed on CFMD, causing ACS. We report the first case series of SCAD and concomitant fibromuscular dysplasia (FMD).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical Presentation, Management, and Outcomes of Angiographically Documented Early, Late, and Very Late Stent Thrombosis FREE

Ehrin J. Armstrong, MD; Dmitriy N. Feldman, MD; Tracy Y. Wang, MD, MHS, MS; Lisa A. Kaltenbach, MS; Khung-Keong Yeo, MBBS; S. Chiu Wong, MD; John Spertus, MD; Richard E. Shaw, PhD; Robert M. Minutello, MD; Issam Moussa, MD; Kalon K.L. Ho, MD; Jason H. Rogers, MD; Kendrick A. Shunk, MD, PhD

Objectives: The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST).

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Calcified In-Stent Restenosis. A Rare Cause of Dilation Failure Requiring Rotational Atherectomy

Fernando Alfonso, MD, Jorge Sandoval, MD and Christian Nolte, MD

The acute results of repeated interventions for patients with in-stent restenosis (ISR) are largely satisfactory, although some patients may still have recurrences.1,2 In this anatomic scenario, lack of initial angiographic success is exceedingly rare.1,2 We report a patient with “undilatable” ISR that eventually required rotational atherectomy to achieve procedural success. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) unraveled the presence of severely calcified intrastent tissue, leading to “resistant” ISR.

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Principles of Percutaneous Paravalvular Leak Closure FREE CME

Charanjit S. Rihal, MD; Paul Sorajja, MD; Jeffrey D. Booker, MD; Donald J. Hagler, MD; Allison K. Cabalka, MD

Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. For paramitral defects, an antegrade transseptal approach can usually be guided by biplane fluoroscopy, and real-time 3-dimensional transesophageal echocardiography can usually be performed successfully. Alternative approaches to paramitral defects include retrograde transaortic cannulation or transapical access and retrograde cannulation. For oblong or crescentic defects, the simultaneous or sequential deployment of 2 smaller devices, as opposed to 1 large device, results in a higher degree of procedural success and safety because the risk of impingement on the prosthetic leaflets is minimized. Most para-aortic defects can be approached in a retrograde manner and closed with a single device. With careful anatomical assessment, procedural planning, and procedural execution, successful closure rates of 90% or more should be attainable with a low risk of device impingement on the prosthetic valve or embolization.

01 febrero 2012

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Radial Artery Patency After Transradial Catheterization

Mark A. Kotowycz, MD, MBA, FRCPC and Vladimír Džavík, MD, FRCPC, FAHA

The transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications1–3 and has been shown to reduce major bleeding when compared with the femoral approach.4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization.3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients4–6 and is associated with decreased cost.5,7,8