"Subintimal external crush" technique for a "balloon uncrossable" chronic total occlusion.

Chronic total occlusion (CTO) revascularization is traditionally limited by the challenges related to lesion crossing. In a smaller number of cases, however, inability to advance the balloon catheter to the crossing site can account for recanalization failure ("balloon uncrossable" CTO). We describe a case of a "balloon uncrossable" CTO in which balloon crossing was achieved after subintimal dilation and "external crushing" of the CTO lesion resulting in significant modification of the CTO atheromatous plaque.

Effect of Extended-Release Niacin on Saphenous Vein Graft Atherosclerosis: Insights from the Atherosclerosis Lesion Progression Intervention Using Niacin Extended Release in Saphenous Vein Grafts (ALPINE-SVG) Pilot Trial.

Background: Intermediate saphenous vein graft (SVG) lesions have high rates of progression. The purpose of this study was to examine the impact of extended-release niacin (ER-niacin) vs placebo on intermediate SVG lesions.

Methods: Patients with intermediate (30%-60% diameter stenosis) SVG lesions were randomized to ER-niacin vs placebo for 12 months.

Comparison of Iodixanol and Ioxaglate for Coronary Optical Coherence Tomography Imaging.

Background: The impact of contrast type on coronary imaging using optical coherence tomography (OCT) has received limited study. We compared OCT imaging obtained using the non-ionic, iso-osmolar iodixanol with the ionic, low-osmolar ioxaglate.

Methods: Twenty-two vessels in 20 patients were imaged twice using manual injection of iodixanol and ioxaglate in random order.

The Double-Blind Stick-and-Swap Technique for True Lumen Reentry After Subintimal Crossing of Coronary Chronic Total Occlusions.

Subintimal dissection and reentry techniques are widely used in chronic total occlusion (CTO) interventions; however, inability to reenter into the distal true lumen is a common cause of failure. In some patients, subintimal hematoma may develop, compressing the lumen and hindering reentry. We describe 3 CTO cases in which the distal vessel could not be visualized after subintimal crossing, in spite of attempts to decompress the subintimal hematoma.

Long-term outcomes with first- vs. second-generation drug-eluting stents in saphenous vein graft lesions.

Background: As compared with bare metal stents, first-generation drug-eluting stents (DES) improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES in SVGs.

Methods: We compared the outcomes of patients who received first- (n = 81) with those who received second-generation (n = 166) DES in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization.

Prevalence and treatment of "balloon-uncrossable" coronary chronic total occlusions.

Background: The frequency and outcomes of "balloon-uncrossable" coronary chronic total occlusions (CTOs) have received limited study.

Methods: We retrospectively examined 373 consecutive CTO percutaneous coronary interventions (PCIs) performed at our institution between 2005 and 2013 to determine the frequency and treatment of balloon-uncrossable CTOs.

Results: Mean age was 63.

Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry.

Objectives: To examine the impact of transradial access on the procedural outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI).

Background: The efficacy and safety of transradial access in CTO PCI has received limited study.

Methods: We compared the technique and outcomes of transradial vs.

Procedural failure of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US registry.

Background: The hybrid approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly increased procedural success rates, yet some cases still fail. We sought to evaluate the causes of failure in a contemporary CTO PCI registry.

Methods: We examined 380 consecutive patients who underwent CTO-PCI at 4 high volume CTO PCI centers in the United States using the "hybrid" approach.

Percutaneous intervention of circumflex chronic total occlusions is associated with worse procedural outcomes: insights from a Multicentre US Registry.

Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA).

Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March 2014.

Results: The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%).

Thrombin injection for sealing epicardial collateral perforation during chronic total occlusion percutaneous coronary interventions.

Epicardial collateral perforation is a serious complication of retrograde chronic total occlusion percutaneous coronary intervention. We describe two cases of epicardial collateral perforation that were successfully sealed with local thrombin injection.

The efficacy and safety of the "hybrid" approach to coronary chronic total occlusions: insights from a contemporary multicenter US registry and comparison with prior studies.

Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is challenging and has been associated with low success rates. However, recent advancements in equipment and the flexibility to switch between multiple technical approaches during the same procedure ("hybrid" percutaneous algorithm) have dramatically increased the success of CTO-PCI. We sought to compare the contemporary procedural outcomes of hybrid CTO-PCI with previously published CTO-PCI studies.

Application of the "hybrid approach" to chronic total occlusions in patients with previous coronary artery bypass graft surgery (from a Contemporary Multicenter US registry).

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been traditionally associated with lower success rates in patients with previous coronary artery bypass graft surgery (CABG). We sought to examine the success and complication rates of CTO PCI using the "hybrid" crossing algorithm among patients with a history of previous CABG. The procedural outcomes of 496 consecutive CTO PCIs performed at 5 high-volume PCI centers in the United States from January 2012 to August 2013 were assessed.

Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: a weighted meta-analysis of 280 patients from eight studies.

Background: Preoperative bridging with a glycoprotein IIb/IIIa inhibitor is often performed in patients with prior coronary stents undergoing surgery who require antiplatelet therapy discontinuation, but its safety and efficacy have received limited study. We performed a weighted meta-analysis of the outcomes in patients with coronary stents undergoing bridging with glycoprotein IIb/IIIa inhibitors prior to surgery.

Methods: We conducted a weighted meta-analysis of preoperative bridging studies published between 2002 and 2013 in patients with coronary stents undergoing surgery.

The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: insights from a US multicenter registry.

Objectives: To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR).

Background: PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs.

Torsade de Pointes and Persistent QTc Prolongation after Intravenous Amiodarone.

We report a case of torsade de pointes after intravenous amiodarone and concurrent hypokalemia. Despite treatment cessation and correction of electrolyte abnormalities, excessive QTc prolongation was noted, which persisted for 14 days. This prolonged course for QTc normalization may be attributed to the high rate of amiodarone loading and concurrent electrolyte disturbances coupled with possible underlying individual variability in pharmacokinetics.

Effect of a synthetic peptide corresponding to residues 313 to 320 of the alphaIIb subunit of the human platelet integrin alphaIIbbeta3 on carotid artery thrombosis in rabbits.

The platelet integrin receptor alpha(IIb)beta(3) plays a critical role in thrombosis. We have shown previously that the octapeptide YMESRADR, corresponding to sequences 313 to 320 of the human alpha(IIb) subunit, inhibits human platelet activation and fibrinogen binding to alpha(IIb)beta(3), possibly interacting with the ligand. We investigated the effect of YMESRADR on electrically induced carotid artery thrombosis in New Zealand white rabbits.

Automated diagnosis of coronary artery disease based on data mining and fuzzy modeling.

A fuzzy rule-based decision support system (DSS) is presented for the diagnosis of coronary artery disease (CAD). The system is automatically generated from an initial annotated dataset, using a four stage methodology: 1) induction of a decision tree from the data; 2) extraction of a set of rules from the decision tree, in disjunctive normal form and formulation of a crisp model; 3) transformation of the crisp set of rules into a fuzzy model; and 4) optimization of the parameters of the fuzzy model. The dataset used for the DSS generation and evaluation consists of 199 subjects, each one characterized by 19 features, including demographic and history data, as well as laboratory examinations.