Positive Murphy's Sign in Pericardial Hematoma from a Right Atrial Tear.

A positive Murphy's sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy's sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure.

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.

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.

Relationship of walking impairment and ankle-brachial index assessments with peripheral arterial translesional pressure gradients.

Background: The relationship of peripheral arterial mean translesional pressure gradient (TLG) to presenting symptom, functional impairment, and initial noninvasive ABI assessments has never been established.

Objectives: To evaluate the association between TLG, severity of walking impairment, rest and exercise ankle-brachial indices (ABI).

Methods: TLG in 19 patients presenting with claudication and single superficial femoral artery lesion were measured invasively.

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.

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.

Carotid access for cardiac catheterization: revisiting the past for a complex intra-arterial approach.

Historically, multiple arterial access sites have been used for cerebral, peripheral or coronary angiography prior to the widespread utilization of the safer transbrachial and, more recently, transfemoral or transradial approaches. Additionally, alternative sites for arterial access such as the carotid artery are often used in complex pediatric invasive procedures. We describe a case of a patient with severe peripheral arterial occlusive disease with active ischemia who required coronary angiography.

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%).

Dual guide catheter technique for treating native coronary artery lesions through tortuous internal mammary grafts: separating equipment delivery from target lesion visualization.

Attempts to wire and stent a native coronary artery lesion through a tortuous internal mammary graft can result in graft occlusion, ischemia, and inability to visualize the distal lesion. We report three cases in which treatment of such lesions was successfully completed using two guiding catheters, one of which was used for lesion visualization and one for equipment delivery.

Clinical presentation and angiographic characteristics of saphenous vein graft failure after stenting: insights from the SOS (stenting of saphenous vein grafts) trial.

Objectives: We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS).

Background: The mode of SVG failure after stenting has been poorly characterized.

Methods: The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES.

Treatment of complex superficial femoral artery lesions with PolarCath cryoplasty.

Use of cryoplasty in patients with severely symptomatic (Rutherford category > or =3) superficial femoral artery (SFA) disease has not been systematically evaluated. From August 2006 to October 2007, 27 consecutive, severely symptomatic patients with 39 lesions in 36 limbs underwent SFA cryoplasty using the PolarCath at 2 centers. Mean age was 74 +/- 12 years and 48% were men; 41% had diabetes, 59% had coronary artery disease, and 61% had complex lesions (ostial, calcified, chronic total occlusion, in-stent restenosis, or length > or =150 mm).

"Armored" aspiration catheter technique to enhance aspiration catheter delivery in challenging thrombus-containing lesions.

Use of aspiration catheters can improve the outcomes of percutaneous coronary interventions in thrombus-containing lesions, yet delivery of such catheters may be difficult, especially in tortuous and calcified vessels and when guide catheter support is poor. We report two cases demonstrating successful application of a novel "armored" aspiration catheter technique, in which a 0.035 inch guidewire is inserted via the aspiration lumen to render the aspiration catheter stiffer and facilitate delivery to the target vessel thrombotic segment.

A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial.

Objectives: The aim of this study was to compare the frequency of angiographic restenosis and clinical events between a paclitaxel-eluting stent (PES) and a similar bare-metal stent (BMS) in saphenous vein graft (SVG) lesions.

Background: There are conflicting and mostly retrospective data on outcomes after drug-eluting stent implantation in SVGs.

Methods: Patients requiring SVG lesion stenting were randomized to BMS or PES.