Percutaneous vertebral artery intervention: a necessary tool in every interventional cardiologist armamentarium.

Objectives: The purpose of this study was to evaluate the results of endovascular treatment of symptomatic vertebrobasilar insufficiency unresponsive to medical therapy.

Methods: Twenty-eight patients who were regularly followed up in our cardiology clinic with symptoms suggestive of posterior fossa ischemia and with diagnostic or suspicious findings on ultrasound evaluation were evaluated with selective vertebral and subclavian artery angiography. All patients (17 men, 11 women; mean age, 64 years; range, 54-87) had critical lesions (>70% stenosis) in the vertebral or subclavian arteries or both.

The no-flow phenomenon during diagnostic coronary angiography.

Objectives: Slow flow of dye in epicardial coronary arteries is not an infrequent finding in patients during routine coronary angiography. The extreme form of this phenomenon, namely, no flow or Thrombolysis in Myocardial Infarction (TIMI) 0-1, is very uncommon with life-threatening consequences. We consider the present report as the first one, to our knowledge, that describes this angiographic entity and how prompt recognition and adequate management prevent certain death in this population.

Safety of elective--including "high risk"--percutaneous coronary interventions without on-site cardiac surgery.

Background: Current guidelines (American College of Cardiology/American Heart Association) for percutaneous coronary intervention (PCI) limit the performance of elective cases to hospitals with the capability for cardiac surgery. The number of hospitals in the United States with this capability is limited, which restricts availability of this proven technology.

Objective: To determine the safety of performing elective, nonselected PCI in hospitals without cardiac surgery capability.

Stenting the stent: alternative strategy for treating in-stent restenosis.

Several approaches have been taken to relieve restenosis inside a vascular stent. In a patient with a complicated history of coronary artery disease, a restenotic lesion inside a Gianturco-Roubin flex stent was relieved by angioplasty and deployment of three 10 mm Palmaz P-104 "biliary" stents, with urokinase and verapamil used to prevent thromboembolism and the no-reflow phenomenon. An angiographic study 6 months later showed a patient graft with no residual stenosis.

Transcatheter therapy of thrombotic-occlusive lesions in saphenous vein grafts.

Saphenous vein graft (SVG) disease, a form of accelerated atherosclerosis, remains a therapeutic conundrum. The use of stents after excluding the presence of thrombus has proved highly successful at short- and long-term follow-up. We report on 60 severely symptomatic patients with multiple subtotal and total thrombotic SVG occlusions who were treated with a combination of intragraft urokinase-verapamil infusion and insertion of multiple biliary stents.

Urokinase infusion after unsuccessful angioplasty in patients with chronic total occlusion of native coronary arteries.

Percutaneous transluminal coronary angioplasty (PTCA) is often unsuccessful in patients with chronic total occlusion of coronary arteries. In this study, prolonged urokinase infusion (< or = 24 hr) was administered to 20 patients with chronic total coronary artery occlusion in whom previous PTCA had failed. An intracoronary bolus of urokinase, 120,000 IU, was followed by urokinase infusion, up to 200,000 IU/hr, if necessary, until angiography demonstrated reperfusion and a guiding wire could be advanced past the occlusion site.