Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II).

Objectives: The ORBIT II (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) trial evaluated the safety and efficacy of the coronary Orbital Atherectomy System (OAS) to prepare de novo, severely calcified coronary lesions for stent placement.

Background: Despite advances in interventional techniques, treatment of calcified coronary lesions remains a challenge. Stent placement in these lesions may result in stent underexpansion, malapposition, and procedural complications.

Troponin I levels in patients with preeclampsia.

Introduction: Preeclampsia involves a diffuse inflammatory state and elevated levels of troponins in patients with preeclampsia have been anecdotally reported. It is, however, unknown whether it is attributable to the preeclampsia.

Objective: We sought to determine the troponin I levels at the time of delivery in pregnant women with and without preeclampsia.

Presence of asymmetric dimethylarginine gradients across high-grade lesions in patients with coronary artery disease.

Background: Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, is a systemic marker of endothelial dysfunction. Although experimental evidence indicates that asymmetric dimethylarginine may play an important role in atherogenesis, local asymmetric dimethylarginine levels have not been measured in vivo.

Objectives: We sought to determine whether: (i) asymmetric dimethylarginine is elevated locally at sites of coronary lesions, (ii) systemic asymmetric dimethylarginine concentrations correlate with local levels, and (iii) percutaneous coronary intervention produces immediate local asymmetric dimethylarginine elevation.

The influence of low (81 mg) versus high (325 mg) doses of ASA on the incidence of sirolimus-eluting stent thrombosis.

Background: Conflicting opinion exists regarding the optimal dose of acetyl salicylic acid (ASA) to be given after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We sought to evaluate the influence of ASA dose on the incidence of unexplained subacute and late stent thrombosis in the era of DES.

Methods: We performed a retrospective analysis of the incidence of subacute and late stent thrombosis in our patient population over a 2-year period.

Alcohol septal ablation after failed surgical myectomy.

We describe the case of a successful alcohol septal ablation in a patient with persistent gradient and severe symptoms postsurgical myectomy. The alcohol ablation of the thickened septum abolished the left ventricular outflow gradient and the systolic anterior motion (SAM) of the mitral valve. Although the surgical literature advocates for mitral valve replacement in patients who continue to have SAM with significant outflow obstruction postmyectomy, targeted alcohol septal ablation of the remaining septum appears to be an attractive alternative.

Invasive assessment of mitral regurgitation: comparison of hemodynamic parameters.

Objectives: We sought to analyze several new hemodynamic characteristics which address the interplay of left atrial (LA) and left ventricular (LV) pressures, as well as to re-analyze several other V wave characteristics employed in the determination of mitral regurgitation (MR) severity in order to determine which, if any, had adequate correlation with grade of MR for clinical utility.

Background: Invasive assessment of mitral regurgitation includes analysis of intracardiac pressures and LV angiography. The V wave, when obtained from the pulmonary capillary wedge position (PCWP), and its various characteristics are believed to be of limited value for prediction of MR severity.

Clinical experience with rotational atherectomy in patients with severe left ventricular dysfunction.

Objective: To evaluate the safety and efficacy of rotational atherectomy (RA) in patients with severe left ventricular (LV) dysfunction.

Background: RA, using a rotating diamond-crystal burr, is most commonly used to open lesions with severe calcification or diffuse disease that may prove difficult to cross or dilate. However, RA generates microparticular debris that may attenuate the coronary microcirculation, inducing transient myocardial stunning and LV dysfunction.

Coronary artery perforation during percutaneous coronary intervention: incidence and outcomes in the new interventional era.

Background: Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa).

Methods: We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period.

Antiplatelet therapy in anticoagulated patients requiring coronary intervention.

Objective: To define the optimal antiplatelet regime in patients requiring long-term anticoagulation who undergo percutaneous coronary intervention.

Background: Antiplatelet therapy following coronary intervention consists of a regime of aspirin and clopidogrel for the prevention of subacute stent thrombosis. The optimal antiplatelet therapy post-coronary intervention in patients on ongoing anticoagulation therapy remains to be defined.

The efficacy of brain natriuretic peptide levels in differentiating constrictive pericarditis from restrictive cardiomyopathy.

Objectives: We sought to determine the usefulness of brain natriuretic peptide (BNP) measurements to differentiate constrictive pericarditis (CP) from restrictive cardiomyopathy (RCMP).

Background: The differentiation of CP from RCMP may be clinically difficult and often requires hemodynamic assessment. No laboratory marker has been shown to differentiate the two conditions.

Cardiovascular manifestations of acute intracranial lesions: pathophysiology, manifestations, and treatment.

The objective of this article was to review the effects of acute intracranial lesions on myocardial function. The authors reviewed scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through January 2002. Pertinent literature was referenced, including clinical and laboratory investigations, to demonstrate the effects of acute intracranial lesions on the cardiovascular system.

Use of intravenous abciximab as adjunctive therapy for carotid angioplasty and stent placement.

The benefit of intravenous abciximab as an adjunctive to percutaneous coronary intervention has been demonstrated in large-scale randomized studies. The role of intravenous abciximab is being defined in carotid angioplasty and stent placement as the procedure is gaining popularity for the treatment of high-grade carotid stenosis in patients considered high-risk for carotid endarterectomy. This paper summarizes the pathophysiological basis and the available data for the use of abciximab as an adjunct to carotid artery stenting.