Recurrent minor strokes/TIA with a right to left shunt.

A patient came to our institution for evaluation and closure of suspected patent foramen ovale actively manifesting as cerebrovascular accident. Through further studies, we found the presence of a pulmonary arteriovenous fistula, which was subsequently and successfully closed through non-invasive percutaneous selective segmental pulmonary artery embolisation.

The safety and efficacy of peripheral vascular procedures performed in the outpatient setting.

Objectives: This study sought to evaluate the safety and efficacy of peripheral vascular interventions performed in a private, outpatient catheterization laboratory.

Background: Peripheral vascular interventions have been traditionally performed in the inpatient setting. However, there has been a recent shift away from hospital-based vascular interventions toward outpatient-based procedures.

Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease.

We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved.

Treating peripheral arterial disease percutaneously with atherectomy.

Purpose: To determine clinical outcomes of patients who underwent percutaneous revascularization (PR) with multiple devices.

Methods: PR cases at a private, tertiary referral hospital were reviewed retrospectively. Limb salvage and patency rates were calculated by the Kaplan Meier method.

Therapeutic hypothermia for acute myocardial infarction and cardiac arrest.

This report focuses on cardioprotection and describes the advantages and disadvantages of various methods of inducing therapeutic hypothermia (TH) with regard to neuroprotection and cardioprotection for patients with cardiac arrest and ST-segment elevation myocardial infarction (STEMI). TH is recommended in cardiac arrest guidelines. For patients resuscitated after out-of-hospital cardiac arrest, improvements in survival and neurologic outcomes were observed with relatively slow induction of TH.

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience.

Background: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution.

High-risk percutaneous coronary intervention with the TandemHeart and Impella devices: a single-center experience.

Background: Intra-aortic balloon pumps (IABPs) are indicated during high-risk percutaneous coronary intervention (HR-PCI) to reduce major procedural complications. The clinical utility of the newer Impella and TandemHeart devices is not clear. This study determined the baseline characteristics, hemodynamics, and outcomes of patients treated with prophylactic percutaneous left ventricular assist devices (PLVADs) during HR-PCI.

Rotational atherectomy in the drug-eluting stent era: a single-center experience.

Background: In heavily calcified lesions, rotational atherectomy (RA) improves procedural success and facilitates stent deployment. Reports on RA in the drug-eluting stent (DES) era are limited. The objective of this study was to determine the presenting characteristics, procedural and in-hospital clinical outcomes of patients who underwent RA at our institution in the DES era.

Study to determine the clinical significance of HEmolysis During Orbital AtheRectomy (CLEAR study).

Purpose: To evaluate the incidence of clinically evident hemolysis associated with orbital atherectomy used to treat severe peripheral artery disease.

Methods: The observational CLEAR study enrolled 31 subjects (16 men; mean age 71 ± 10 years, range 44-92) with claudication (58.1%) or critical limb ischemia (38.

Review of vascular closure devices.

Vascular access-site complications are an important cause of morbidity following catheterization procedures. Manual compression is the "gold standard" in achieving hemostasis of an arteriotomy site; however, manual compression is limited by the need to interrupt anticoagulation, prolonged bed rest, patient discomfort and time demands for healthcare providers. Vascular closure devices (VCDs) improve patient comfort, free medical staff resources and shorten the time needed for hemostasis, ambulation and discharge.

Peripheral chronic total occlusions treated with subintimal angioplasty and a true lumen re-entry device.

Objective: We sought to verify how effective the Pioneer catheter (Medtronic, Inc., Minneapolis, Minnesota) is in overcoming the complexity of re-entry during subintimal angioplasty and provide a case series describing the technique.

Background: Subintimal angioplasty is effective in treating peripheral chronic total occlusions (CTO).

Use of high-frequency vibrational energy in the treatment of peripheral chronic total occlusions.

Purpose: Peripheral chronic total occlusions (CTO) are challenging lesions to treat. The CROSSER system (FlowCardia, Sunnyvale, CA) uses high-frequency low-amplitude vibrations to break through the cap of the CTO and had been shown to be successful in coronary CTOs. This is a case series demonstrating the use of the CROSSER system with peripheral CTOs.

Complication rate of diagnostic carotid angiography performed by interventional cardiologists.

Objective: The aim of this study was to evaluate the complication rate of diagnostic carotid angiography performed by interventional cardiologists and compare it to previously published data.

Background: Percutaneous treatment for carotid artery stenosis is increasingly being performed. Previously published data describes the complication rate of diagnostic carotid angiography performed by radiologists and vascular surgeons, yet the information regarding interventional cardiologists is sparse.

AngioJet Rheolytic thrombectomy during rescue PCI for failed thrombolysis: a single-center experience.

Background: Previous studies have shown the efficacy of AngioJet Rheolytic Thrombectomy (RT) in reducing thrombus burden and improving coronary flow in acute myocardial infarction (MI). No study has specifically evaluated the use of AngioJet RT in patients undergoing rescue percutaneous coronary intervention (PCI) for failed thrombolysis, a setting that may be particularly beneficial given the extensive thrombus burden. The objective of this study was to evaluate the efficacy and safety of AngioJet RT during rescue PCI for failed thrombolysis.

Rescue percutaneous coronary intervention for failed thrombolysis.

Background: Previous studies of rescue percutaneous coronary intervention (PCI) for failed thrombolysis yielded conflicting results. In the current era of newer thrombolytic agents, coronary stents, glycoprotein IIb/IIIa inhibitors, and aggressive hemodynamic support, the outcome of this high-risk patient group has not been characterized.

Methods: From January 2000 to October 2004, 214 consecutive patients were transferred and underwent emergent coronary angiography following failed thrombolysis.