Left main intervention in myocardial infarction.

We report an 84-year-old patient who suddenly developed nausea, vomiting, hypotension, and needed intubation, assisted ventilation and pharmacological vasopressor support. Admission EKG showed anterior and lateral leads ST segment depression and 2 mm ST segment elevation in avR lead. Angiogram showed unprotected left-main coronary-artery (LM) sub-occlusive disease and totally occluded ostial right-coronary-artery (RCA), distally filled through the left-coronary system.

Incidence, location, magnitude, and clinical correlates of saphenous vein graft calcification: an intravascular ultrasound and angiographic study.

Background: The pattern of saphenous vein graft (SVG) calcification before percutaneous intervention has not been studied.

Methods And Results: We used diagnostic and preintervention intravascular ultrasound (IVUS) to determine the incidence and magnitude of SVG calcification in 334 SVG lesions in 274 consecutive patients. Calcium was found in 133 SVGs (40%).

Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.

Background: Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI).

Methods And Results: We used intravascular ultrasound (IVUS) to assess 78 coronary arteries (38 infarct-related arteries [IRAs] with culprit and nonculprit lesions and 40 non-IRAs) from 38 consecutive AMI patients. IVUS analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area.

Late thrombosis after gamma-brachytherapy.

Late stent thrombosis (> 30 days after treatment) is a new phenomenon occurring after vascular brachytherapy. We report the analysis of 11 patients with late thrombosis after gamma-irradiation treatment of in-stent restenosis. All patients had in-stent restenosis and angina.

Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound.

Objectives: This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS).

Background: Acute coronary syndromes result from spontaneous plaque rupture and thrombosis.

Methods: We report 300 plaque ruptures in 257 arteries in 254 patients.

Percutaneous interventions in patients with cocaine-associated myocardial infarction: a case series and review.

Cocaine-associated myocardial infarction (CAMI) is a well-reported entity. Most previous reports on CAMI have been limited to conservative care utilizing benzodiazepines, aspirin, nitroglycerin, calcium channel blockers, and thrombolytics. Current guidelines on CAMI advocate immediate use of angiography and angioplasty if available rather than routine administration of thrombolytics.

Dose heterogeneity may not affect the neointimal proliferation after gamma radiation for in-stent restenosis: a volumetric intravascular ultrasound dosimetric study.

Objectives: The goal of this study was to use serial (postirradiation and follow-up) volumetric intravascular ultrasound (IVUS): 1) to evaluate the actual distribution of gamma radiation in human in-stent restenosis (ISR) lesions, and 2) to analyze the relationship between neointimal regrowth and the delivered radiation dose.

Background: The relationship between the neointimal regrowth and delivered dose during the treatment of ISR remains unknown.

Methods: We analyzed 20 actively (gamma emitter) treated, native artery ISR patients from the Washington Radiation for In-Stent restenosis Trial (WRIST) that met the following criteria: on both postirradiation and six-month follow-up IVUS imaging, > or =80% of the external elastic membrane circumference could be identified throughout the treated length including the lesion and proximal and distal reference segments.

Incidence, morphology, angiographic findings, and outcomes of intramural hematomas after percutaneous coronary interventions: an intravascular ultrasound study.

Background: Intramural hematomas during percutaneous coronary intervention (PCI) have not been well studied.

Methods And Results: We used intravascular ultrasound to determine the incidence, morphology, and clinical features of post-PCI intramural hematomas. In 905 patients with 1025 consecutive native coronary artery, non-in-stent restenosis lesions undergoing PCI, 72 hematomas were detected in 69 arteries in 68 patients.