Evaluating Equivocal Left Main Stenosis with Fractional Flow Reserve - Not all Daughter Vessels are Created Equally.

Fractional flow reserve (FFR) evaluation of intermediate left main coronary artery (LMCA) stenosis has been validated in clinical decision-making. However, the size of the daughter vessel, in which the FFR transducer is placed and the amount of myocardium it subtends, has received less attention. We present a case that demonstrates the importance of transducer location, size of the daughter vessel and the amount of subtended myocardium in evaluation of LMCA stenosis, pointing out potential pitfalls.

The importance of malapposition in angiographically optimized stenting in contemporaneous interventions.

Stenting has advanced the treatment of coronary artery disease, with angiography being historically the gold standard to assure adequate stent deployment. However, intravascular imaging modalities including intravascular ultrasound and optical coherence tomography have shown high rates of inadequate stent deployment in angiographically optimized stents. The association of malapposition with adverse clinical outcomes remains controversial.

Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention.

Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain.

Prevalence and outcomes of intermediate saphenous vein graft lesions: findings from the stenting of saphenous vein grafts randomized-controlled trial.

Background: We sought to examine the prevalence and progression rate of intermediate saphenous vein graft (SVG) lesions in the Stenting Of Saphenous vein grafts (SOS) trial.

Methods: The baseline and follow-up angiograms of 80 patients participating in the SOS trial were analyzed to determine the prevalence of intermediate (30-60% angiographic diameter stenosis) SVG lesions and their progression rate.

Results: At least one intermediate SVG lesion was present in 31 of 143 (22%) SVGs in 27 of 80 (34%) patients.

Optical coherence tomography analysis of the stenting of saphenous vein graft (SOS) Xience V Study: use of the everolimus-eluting stent in saphenous vein graft lesions.

Objectives: The Stenting of Saphenous Grafts-Xience V (SOS-Xience V) trial prospectively examined the frequency of angiographic in-stent restenosis in saphenous vein graft (SVG) lesions 12 months after implantation of a Xience V everolimus-eluting stent (EES; Abbott Vascular). Optical coherence tomography (OCT) during follow-up angiography was added to the protocol after OCT was approved for clinical use in the United States.

Methods: Forty patients with 40 SVG lesions were enrolled in the study, of whom 27 underwent 12-month coronary angiography and 12 (only 1 of whom had in-stent restenosis) also had follow-up OCT evaluation.

Frequency, treatment, and consequences of device loss and entrapment in contemporary percutaneous coronary interventions.

Background: Device loss and entrapment are infrequent but potentially grave complications of percutaneous coronary interventions (PCI). There are limited contemporary data on the frequency, treatment, and consequences of these complications.

Methods: We reviewed 2338 consecutive PCI cases performed between 1/2005 and 5/2010 at our institution to identify cases of device loss or entrapment.

Embolic protection device utilization during stenting of native coronary artery lesions with large lipid core plaques as detected by near-infrared spectroscopy.

Background: Stenting of large lipid core plaques (LCPs), as assessed by near-infrared spectroscopy (NIRS), has been associated with periprocedural myocardial infarction (MI), possibly due to distal embolization.

Methods: An embolic protection device (EPD) was inserted before stenting in nine native coronary arteries with large LCP, as assessed by NIRS. Embolized material was assessed by histopathology.

Role of embolic protection devices in ostial saphenous vein graft lesions.

Background: Although embolic protection devices (EPDs) have been shown to be beneficial in saphenous vein graft (SVG) lesions, their role in the subgroup of ostial SVG lesions has received limited study.

Methods: The coronary angiograms and procedural outcomes of 109 patients undergoing stenting of 113 ostial SVG lesions were retrospectively reviewed to determine the frequency of EPD use and the periprocedural outcomes.

Results: Ninety-eight (87%) of the 113 lesions were suitable for EPD use, that was used in 70 lesions (71%).

In vivo comparison of Fourier-domain optical coherence tomography and intravascular ultrasonography.

Background: We sought to evaluate the findings of Fourier-domain optical coherence tomography (FD-OCT) and intravascular ultrasonography (IVUS) used for the in vivo assessment of coronary lesions.

Methods: We identified 19 lesions in 15 patients undergoing percutaneous coronary intervention that were assessed by both FD-OCT and IVUS and compared the lumen area and maximum/minimum lumen diameter at the site of maximum stenosis and the proximal and distal reference cross-sections.

Results: At the site of maximum stenosis, excellent correlation was found between FD-OCT and IVUS measurements: minimum lumen area (3.

Association of coronary lipid core plaque with intrastent thrombus formation: a near-infrared spectroscopy and optical coherence tomography study.

Background: Optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS) allow assessment of the anatomy (OCT) and composition (NIRS) of coronary lesions. We sought to examine the association between pre-stenting lipid core plaque (LCP), as assessed by NIRS and post-stenting thrombus formation, as assessed by OCT.

Methods: We reviewed the angiograms of nine patients who underwent coronary stenting in association with NIRS and OCT imaging.

Paclitaxel-eluting stents reduce neointimal hyperplasia compared to bare metal stents in saphenous vein grafts: intravascular ultrasonography analysis of the SOS (Stenting of Saphenous Vein Grafts) trial.

Aims: To compare the intravascular ultrasonography (IVUS) findings between saphenous vein grafts (SVG) treated with paclitaxel-eluting stents (PES) vs. bare metal stents (BMS) in the Stenting Of Saphenous Vein Grafts (SOS) trial.

Methods And Results: Of the 80 SOS trial patients, 38 had both baseline and follow-up IVUS examination and were included in this substudy: 17 patients received 28 BMS in 26 lesions and 21 patients received 30 PES in 28 lesions.

In vivo characterization of coronary plaques: novel findings from comparing greyscale and virtual histology intravascular ultrasound and near-infrared spectroscopy.

Aims: To test the hypothesis that near-infrared spectroscopy (NIRS) combined with intravascular ultrasound (IVUS) would provide novel information of human coronary plaque characterization.

Methods And Results: Greyscale-IVUS, virtual histology (VH)-IVUS, and NIRS were compared in 131 native lesions (66 vessels) that were interrogated during catheterization by all three modalities. Greyscale-IVUS detected attenuated and echolucent plaques correlated with NIRS-detected lipid-rich areas.

Recurrent cardiovascular events with paclitaxel-eluting versus bare-metal stents in saphenous vein graft lesions: insights from the SOS (Stenting of Saphenous Vein Grafts) trial.

Unlabelled: The Stenting of Saphenous Vein Grafts (SOS) trial demonstrated a reduction in clinical and angiographic adverse events with paclitaxel-eluting stents (PES) compared to bare-metal stents (BMS) in saphenous vein graft (SVG) lesions, but the rate of recurrent adverse events has not been described.

Methods: We performed a post hoc, landmark analysis to evaluate the risk of event recurrence following a non-fatal initial event among the SOS trial patients (pts).

Results: During a median follow-up of 35 months, the 80 pts enrolled in SOS experienced a total of 78 major cardiovascular events (MACE): 51 in the BMS group and 27 in PES group.

Contemporary outcomes of percutaneous intervention in chronic total coronary occlusions due to in-stent restenosis.

Background: Limited data exist on the treatment of chronic total occlusions (CTO) due to in-stent restenosis (ISR).

Methods: We reviewed the procedural techniques and outcomes of 21 consecutive interventions in CTOs due to ISR.

Results: Mean age was 60±8 years, and all patients were men.

Relation between the presence and extent of coronary lipid core plaques detected by near-infrared spectroscopy with postpercutaneous coronary intervention myocardial infarction.

We aimed to examine whether an association exists between the presence and extent of coronary lipid core plaques (LCPs) detected by near-infrared spectroscopy (NIRS) performed before percutaneous coronary intervention (PCI) with postprocedural myocardial infarction (MI). NIRS was performed in the native coronary arteries of 30 patients before PCI. Angular extent of LCP, lesion segment lipid core burden index, and block chemogram were evaluated.

Contemporary approaches to saphenous vein graft interventions: a survey of 275 interventional cardiologists.

Background: We sought to examine contemporary practice patterns of saphenous vein graft (SVG) interventions.

Methods: A link to a 10-item online questionnaire was completed in June 2009 by 275 (7%) of 3,771 US interventional cardiologists surveyed.

Results: Sixty-five percent of the respondents use an embolic protection device (EPD) in >75% of SVG interventions.

Catastrophic left main coronary artery occlusion following diagnostic coronary angiography: salvage by emergency left main coronary artery stenting.

Acute occlusion of left main coronary artery after diagnostic angiography can be rapidly fatal. We describe two patients with left main disease that developed cardiac arrest shortly after diagnostic coronary angiography. They were both successfully treated with emergency left main stenting while cardiopulmonary resuscitation was being performed.

Continued benefit from paclitaxel-eluting compared with bare-metal stent implantation in saphenous vein graft lesions during long-term follow-up of the SOS (Stenting of Saphenous Vein Grafts) trial.

Objectives: This study sought to report the long-term outcomes after drug-eluting stent (DES) implantation in saphenous vein graft (SVG) lesions in the SOS (Stenting of Saphenous Vein Grafts) trial.

Background: The long-term outcomes after DES implantation in SVGs are poorly studied. Apart from the SOS trial, the only other randomized trial comparing DES with bare-metal stents (BMS) in SVGs reported higher mortality in the DES group at 32 months.

Intercatheter reproducibility of near-infrared spectroscopy for the in vivo detection of coronary lipid core plaques.

Objectives: To evaluate the intercatheter reproducibility of catheter-based intracoronary near-infrared spectroscopy (NIRS) for the detection of coronary lipid core plaques (LCPs).

Background: The intercatheter in vivo reproducibility of coronary NIRS findings has not been evaluated.

Methods: NIRS assessment using an automated pullback catheter was performed in triplicates in 10 patients using two different NIRS catheters to evaluate the reproducibility of the lipid core burden index (LCBI).

Frequency and risk of noncardiac surgery after drug-eluting stent implantation.

Background: Few studies have described the frequency and risk of surgery after drug-eluting stent (DES) implantation.

Methods: The medical records of 827 consecutive patients who received a DES at our institution between January 1, 2005 and July 1, 2008 were retrospectively reviewed to determine the outcomes of patients who subsequently underwent noncardiac surgery.

Results: During a median follow-up of 21 months, 135 patients underwent 191 noncardiac surgeries.

Analysis of saphenous vein graft lesion composition using near-infrared spectroscopy and intravascular ultrasonography with virtual histology.

Objective: To examine the composition of saphenous vein graft (SVG) lesions using two novel modalities, near-infrared spectroscopy (NIRS) and intravascular ultrasonography with virtual histology (IVUS-VH).

Methods: We performed NIRS and IVUS-VH imaging of 23 SVGs in 21 patients undergoing clinically-indicated angiography.

Results: Mean patient and SVG age was 66±7 and 10±7 years, respectively.

Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial.

Background: We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions.

Methods: We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions).

Results: An EPD was used in 60 of 112 lesions (54%).

Percutaneous intervention of acutely occluded saphenous vein grafts: contemporary techniques and outcomes.

Objectives: To examine the contemporary acute and long-term outcomes after percutaneous coronary interventions (PCI) of acutely occluded saphenous vein grafts (SVGs).

Background: PCI of acutely thrombosed SVGs carries low success rates. It is unknown whether outcomes have improved with contemporary PCI techniques.

Hairpin-trap: a novel stent retrieval technique.

We report a novel technique for retrieving lost stents or other equipment from the intravascular space. A hairpin is formed at the distal part of a 0.014 inch coronary guidewire, inserted through the Touhy valve, and used to "hook" the lost stent.