Barriers and facilitators to interhospital transfer of acute pulmonary embolism: An inductive qualitative analysis.

Background: Interhospital transfer (IHT) of patients with acute life-threatening pulmonary embolism (PE) is necessary to facilitate specialized care and access to advanced therapies. Our goal was to understand what barriers and facilitators may exist during this transfer process from the perspective of both receiving and referring physicians.

Methods: This qualitative descriptive study explored physician experience taking care of patients with life threatening PE.

Technological Advances in Stent Therapies: a Year in Review.

Stent technology has rapidly evolved since the first stainless steel bare metal stents with substantial developments in scaffolding, polymer, drug choice, drug delivery, and elution mechanisms. Most recently, there has been the evolution of bioabsorbable vascular scaffolds, potentially eliminating the need for long-term foreign object retention. These rapid developments have led to an ever-expanding selection of new stents, making the choice of which to use in which patient challenging.

Antithrombotic Selection in ST-Segment Elevation Myocardial Infarction: a Year in Review.

In ST-segment elevation myocardial infarction (STEMI), interventional cardiologists must move quickly to safely re-establish blood flow while choosing an antithrombotic to preclude wire thrombosis, aid in the restoration of flow, minimize thrombus propagation, and reduce the risk of stent thrombosis. Currently, operators have a choice between heparin and bivalirudin with the possible addition of glycoprotein IIb/IIIa inhibitors (GPIs). Prior studies have shown that bivalirudin use lowers rates of bleeding, but with a clear risk of acute stent thrombosis.

Cardiovascular mortality prediction in veterans with arm exercise vs pharmacologic myocardial perfusion imaging.

Background: No data exist comparing outcome prediction from arm exercise vs pharmacologic myocardial perfusion imaging (MPI) stress test variables in patients unable to perform treadmill exercise.

Methods: In this retrospective study, 2,173 consecutive lower extremity disabled veterans aged 65.4 ± 11.

The path of least resistance to success in chronic hypertension?

The ROX Coupler is a stented arterial-venous anastomosis intended for implantation in the external iliac artery and vein. Prior studies of the ROX Coupler show that it increases cardiac output, oxygen delivery, and decreases systemic vascular resistance, thereby lowering blood pressure. Clinical data for the ROX Coupler demonstrates significant reduction in blood pressure but proximal venous stenoses have been seen post-implantation requiring treatment.

Dual antiplatelet therapy duration after the placement of a drug-eluting stent: what are the data?

The data supporting the immediate use of dual antiplatelet therapy (DAPT) post implantation of drug-eluting stents (DESs) is irrefutable. DAPT in this early period is necessary to prevent stent thrombosis during endothelialization of the stent, a process known to be delayed when DESs are placed. In addition, DAPT helps prevent thrombosis from plaque rupture that occurs outside of the initial stented area and/or at neo-atherosclerotic lesions within a previously coated stent.

Anomalous left circumflex artery from the right coronary cusp: a benign variant?

Objective: To determine the incidence of angiographically evident coronary artery disease (CAD) of the anomalous left circumflex artery (ALCx).

Background: Due to the acute angulation of its origin from the aorta and its retroaortic course, some have proposed an increase in CAD in these vessels.

Methods: We performed a retrospective cohort study of all patients (n = 5205) presenting for left heart catheterization at the St Louis Veterans Affairs hospital from 2006-2012.

Pre-procedural planning for percutaneous atrial septal defect closure: transesophageal echocardiography compared with cardiac computed tomographic angiography.

Background: The safety and efficacy of percutaneous closure of atrial septal defects (ASDs) is determined by several variables, including defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies.

Objective: We sought to determine the accuracy of computed tomographic angiography (CTA) in predicting a defect's size compared with pre-procedural transesophageal echocardiography (TEE) and to the current "gold standard" balloon sizing by intracardiac echocardiography (ICE).

Methods: Thirty-five consecutive patients referred for possible percutaneous closure of suspected secundum ASD were evaluated with gated multislice CTA after initial TEE screening.

Clinical feasibility of a fully automated 3D reconstruction of rotational coronary X-ray angiograms.

Background: Although fixed view x-ray angiography remains the primary technique for anatomic imaging of coronary artery disease, the known shortcomings of 2D projection imaging may limit accurate 3D vessel and lesion definition and characterization. A recently developed method to create 3D images of the coronary arteries uses x-ray projection images acquired during a 180 degrees C-arm rotation and continuous contrast injection followed by ECG-gated iterative reconstruction. This method shows promise for providing high-quality 3D reconstructions of the coronary arteries with no user interaction but requires clinical evaluation.

Rotational coronary angiography.

The numerous well-documented limitations of standard fixed-acquisition coronary angiography led to the development of rotational angiography. This acquisition method uses automated gantry movements while numerous angiographic projections are obtained, and thus overcomes many of the limitations of standard angiography. This article highlights the techniques, advantages, and disadvantages of each type of rotational angiography currently commercially available.