Mammary to innominate arteriovenous fistula: endovascular management of an anecdotal complication.

An internal thoracic artery pseudoaneurysm associated with an arteriovenous fistula to the innominate vein is a very rare complication after implantation of a cardioverter-defibrillator. We report the successful endovascular management of this unusual complication.

Effect on bleeding, time to revascularization, and one-year clinical outcomes of the radial approach during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

The radial approach during percutaneous coronary intervention (PCI) has been reported to reduce the incidence of bleeding complications. However, the radial approach still accounts for <10% of procedures worldwide and only 1% in the United States. Our objective was to compare the effect of radial versus femoral vascular access on the time to reperfusion, incidence of bleeding complications, and overall clinical outcomes in the setting of primary PCI.

Demographics, treatment and outcome of acute coronary syndromes: 17 years of experience in a specialized cardiac centre.

Background: Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited.

Objective: To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period.

Methods: A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed.

Sustained elevation of serum CD40 ligand levels one month after coronary angioplasty predicts angiographic restenosis.

Background: Percutaneous coronary intervention induces an early inflammatory reaction. The intensity of such a reaction as measured by high-sensitivity C-reactive protein has been correlated with recurrent ischemic events, but its association with restenosis remains uncertain.

Objectives: To characterize the type and duration of the postangioplasty inflammatory reaction and to identify new inflammatory markers correlating with restenosis.

Incidence of stent under-deployment as a cause of in-stent restenosis in long stents.

Although stent under-deployment (SU) has been associated with increased risk of in-stent restenosis, little data have been reported on the incidence of SU in patients presenting with clinical in-stent restenosis. In 59 patients referred for vascular brachytherapy and showing angiographic in-stent restenosis, we sought (1) to determine the incidence of SU using standard intravascular ultrasound (IVUS) criteria (2) to evaluate the effects of repeat angioplasty on further stent expansion. Stented length was 32+/-17 mm and diameter stenosis was 75+/-14%.

Ruptured aneurysm of the left sinus of Valsalva discovered 41 years after a decelerational injury.

We present an unusual case of ruptured aneurysm of the left sinus of Valsalva discovered 41 years after a car accident. Echocardiography was a key element in establishing the diagnosis of this rare anomaly, which is often congenital but has also been reported as acquired or traumatic in origin.

Treatment of bifurcation in-stent restenotic lesions with beta radiation using strontium 90 and sequential positioning pullback technique: procedural details and clinical outcomes.

Background: In-stent restenotic lesions have been problematic for many patients with the need for multiple repeat percutaneous coronary interventions (PCI). The need for repeat PCI has been significantly reduced in patients since the advent of vascular brachytherapy. In-stent restenosis resulting in bifurcation presents even more of a challenge.

Two-year angiographic follow-up of intracoronary Sr90 therapy for restenosis prevention after balloon angioplasty.

Background: Postcoronary angioplasty vascular brachytherapy (VBT) has emerged as a successful intervention for restenosis prevention in some clinical scenarios. Longer-term follow-up after VBT in de novo nonstented lesions has not been reported.

Methods And Results: Thirty patients treated with post-percutaneous transluminal coronary angioplasty (PTCA) VBT with Sr90 underwent clinical and angiographic follow-up at 6 and 24 months.

Effects of plaque composition on vascular remodelling after angioplasty in the MultiVitamins and Probucol (MVP) trial.

Background: The antioxidant probucol reduced coronary restenosis in the MultiVitamins and Probucol (MVP) trial by improving vascular remodelling. Whether calcification limits the extent of adaptive vessel enlargement is not known.

Objective: To determine whether plaque composition at the dilated site affects probucol-induced vascular remodelling after angioplasty.