Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes.

Objectives: To analyze the effectiveness of the transradial approach in reducing bleeding rates following urgent percutaneous coronary intervention (PCI) in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors (GPIs).

Background: PCI and use of GPIs are recommended in acute coronary syndromes, but are strong predictors of severe hemorrhagic complications, which, in turn, are associated with reduced survival. The transradial approach represents a simple and effective solution to reduce vascular access site bleedings, particularly with GPIs.

An arrhythmic storm: a potential complication on opening the umbrella for percutaneous closure of interatrial communications.

Interatrial communications (ICs) have been linked to paradoxic embolism, which may be prevented using both surgical and percutaneous interventions. The case of a 61-year-old woman with a history of transient cerebral ischemic attack who developed repetitive ventricular arrhythmias and an intermittent left branch bundle block immediately after percutaneous closure of an IC is described. Transthoracic echocardiography showed that the device had migrated into the left ventricular outflow tract, and the patient consequently underwent emergency cardiac surgery to retrieve the device and repair the IC.

Emergency coronary artery bypass grafting in patients with acute myocardial infarction treated with glycoprotein IIb/IIIa receptor inhibitors.

Glycoprotein (GP) IIb/IIIa receptor inhibitors before primary angioplasty in patients with ST-elevation acute myocardial infarction (STEMI) are recommended by current guidelines. Thus, an increasing number of patients receive these drugs before coronary angiography, particularly if a between-hospital transfer is needed. However, when coronary anatomy is unsuitable for angioplasty, emergency coronary artery bypass grafting (CABG) under GP IIb/IIIa inhibitor treatment may be needed, with a potential increase in bleeding risk.

Randomized comparison of sirolimus and paclitaxel drug-eluting stents for long lesions in the left anterior descending artery: an intravascular ultrasound study.

Objectives: The goal of this work was to verify whether the superiority of the sirolimus-eluting stent (SES) in inhibiting neointimal hyperplasia could be demonstrated in complex coronary lesions.

Background: Both the SES (Cypher, Cordis, Miami Lakes, Florida) and the paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts) have shown a marked reduction in neointimal hyperplasia compared with bare-metal stents. Intravascular ultrasound (IVUS) is the best method to assess arterial response to stent deployment, but few IVUS data are available comparing complex lesions treated with SES or PES.

Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine.

Background: Primary angioplasty is the best treatment of acute myocardial infarction but fails to achieve adequate myocardial reperfusion in 25% to 30% of patients, despite TIMI grade 3 flow. Drug treatment aimed at reducing the no-reflow phenomenon may improve myocardial salvage, thus preventing left ventricular remodeling. Our aim was to evaluate the impact of abciximab and adenosine on immediate angiographic results and on 6-month left ventricular remodeling.

Simvastatin does not inhibit intimal hyperplasia and restenosis but promotes plaque regression in normocholesterolemic patients undergoing coronary stenting: a randomized study with intravascular ultrasound.

Background: Restenosis after coronary stenting is mainly caused by intimal hyperplasia. Both experimental and clinical studies suggest that statins may be able to inhibit intimal hyperplasia and, therefore, in-stent restenosis (ISR), by mechanisms beyond lipid lowering.

Methods: In a 12-month study, we randomized 71 normocholesterolemic patients to 20 mg simvastatin or no treatment, 2 weeks before elective coronary stenting.

Primary angioplasty for acute myocardial infarction in a patient with a solitary coronary ostium and a "superdominant" right coronary artery.

Coronary artery anomalies (CAAs) are a rare angiographic finding, sometimes associated with acute coronary events. We report on a case of primary angioplasty for inferior acute myocardial infarction (AMI) in a 66-year-old woman with a solitary coronary ostium in the right sinus of Valsalva and a "superdominant" right coronary artery. We also discuss two potential pitfalls of primary angioplasty: correct interpretation of coronary anatomy and approach to challenging lesions.

Role of platelet glycoprotein IIb/IIIa inhibitors in rescue percutaneous coronary interventions.

In the setting of acute myocardial infarction, thrombolytic therapy fails to restore an adequate epicardial flow in a large number of patients. Although an increasing number of patients undergoes a percutaneous coronary intervention (PCI) after failed thrombolysis, this treatment has been poorly investigated. This review focuses particularly on the safety and prognostic impact of glycoprotein (GP) IIb/IIIa receptor inhibitors after failed thrombolysis.

Safety, feasibility, and six-month outcomes of a systematic strategy of direct coronary stenting by a transradial approach in patients with single-vessel disease.

Background: Strategies for percutaneous coronary intervention are continuously evolving, in order to reduce complications and to warrant better immediate and long-term outcomes. We sought to evaluate the safety, feasibility, and long-term outcomes of a systematic strategy of coronary stenting without predilation (direct stenting) via a transradial approach for single-vessel procedures.

Methods: Stenting was performed with Snapper stent and wide inner-lumen, preformed, guiding catheters; 118 minimally-selected patients (59% of all single-vessel procedures performed at our center during the study period) were enrolled: among them 39% presented for acute coronary syndromes, 28% were under glycoprotein IIb/IIIa inhibitor treatment, and 10% had a poor left ventricular function; 130 lesions were treated (1.

Percutaneous ulnar artery approach for primary coronary angioplasty: safety and feasibility.

Transradial approach in primary and rescue angioplasty may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Ulnar cannulation has been proposed for elective procedures in patients not suitable for transradial approach. We here report on 13 patients undergoing primary angioplasty performed using the transulnar approach.

[Acute mitral insufficiency secondary to dehiscence of a Carpentier-Edwards Physio ring: diagnosis with transthoracic echocardiography].

We describe a case of a 63-year-old patient admitted to our hospital because of cardiogenic shock. Past medical records showed anterior myocardial necrosis, myocardial surgery revascularization with apical aneurysmectomy and, 3 weeks before, another coronary artery bypass operation due to malfunction of the previous grafts and mitral annuloplasty with placement of a Carpentier-Edwards Physio no. 28 prosthetic ring.