Three Episodes of Takotsubo Cardiomyopathy with Variant Ballooning Patterns in 2 Elderly Women.

Takotsubo cardiomyopathy can present with transient apical, midventricular, or basal left ventricular ballooning patterns. Reported recurrences of this cardiomyopathy are few. We present the cases of 2 elderly women who each had 3 episodes of takotsubo cardiomyopathy in various ballooning patterns.

Delayed occurrence of radial artery pseudoaneurysm following transradial percutaneous coronary intervention.

Radial artery pseudoaneurysm is rare following transradial catheterization procedures. In this article, we report a 5-month delay in the occurrence of this vascular complication following the completion of transradial coronary intervention in a subject without any underlying vasculitis, representing the longest time lag thus far described. < The occurrence of radial artery pseudoaneurysms after transradial coronary intervention is extremely rare, but typically presents clinically within weeks following arterial cannulation.

Black esophagus: new insights and multicenter international experience in 2014.

Background: Black esophagus or acute esophageal necrosis (AEN) is a striking medical condition characterized by circumferential black appearing esophageal mucosa affecting various lengths of the organ with nearly universal involvement of the distal esophagus and abrupt transition at the gastroesophageal junction. This syndrome is gaining acceptance as an important cause of upper gastrointestinal hemorrhage in hospitalized patients.

Aims: To better describe clinical features, risk factors, associated conditions, etiology, treatment, complications, and outcome in patients with AEN at various medical centers across the globe.

Orbital atherectomy: device evolution and clinical data.

A number of atherectomy devices were developed in the last few years. Among them, the DiamondBack 360° Peripheral Orbital Atherectomy System (Cardiovascular Systems, Inc) was specifically designed to work in severely calcified plaque. This article reviews the history, mechanism of action, evolution, clinical data, and future applications of this particular atherectomy device.

Quantitative assessment of myocardial perfusion using time-density curve analysis after elective percutaneous coronary intervention.

Unlabelled: The aim of this study was to assess myocardial blush (MB) using a novel software algorithm that quantifies time-density curves (TDC) after percutaneous coronary intervention (PCI).

Methods: Thirty-two patients referred for elective PCI were enrolled. TDC curves were generated and mean maximal myocardial contrast density (Dmax) was calculated from 5 regions of interest in the PCI territory.

Twenty-year analysis of trends in the incidence and in-hospital mortality for lower-extremity arterial thromboembolism.

Background: Epidemiology data for lower-extremity arterial thromboembolism (LET) are limited and may result from either acute limb ischemia or an acute exacerbation of critical limb ischemia. Given marked changes in both diagnosis and therapy over the last 2 decades, we hypothesized that this time period would have witnessed reductions in both the incidence and in-hospital mortality of LET.

Methods And Results: Data from 1988 through 2007 from the National Hospital Discharge Survey were analyzed.

Transradial access for peripheral vascular interventions.

Transradial access for coronary interventions has grown substantially in the last few years. Currently, there is an increased interest in applying this approach to peripheral vascular interventions. This report reviews the current status of transradial peripheral interventions, and offers advice in terms of feasibility, equipment use, and technical challenges.

Stroke due to late device thrombosis following successful percutaneous patent foramen ovale closure.

We report a case of stroke due to device thrombosis occurring three years following percutaneous patent foramen ovale (patent foramen ovale) closure with an Amplatzer atrial septal occluder device. We discuss risk factors that may have contributed to device thrombosis and raise concerns regarding the lack of a dedicated PFO closure device for clinical use in the United States.

Endoluminal treatment of peripheral chronic total occlusions using the Crosser® recanalization catheter.

Purpose: Revascularization of lower extremity chronic total occlusions (CTOs) is technically challenging. The Crosser® recanalization catheter was designed to facilitate distal vessel intraluminal entry that is both rapid and safe. We present our experience with the Crosser device as primary therapy for peripheral CTOs.

Effects of a percutaneous mechanical circulatory support device for medically refractory right ventricular failure.

Background: Medically refractory right ventricular failure (MR-RVF) is associated with high in-hospital mortality and is managed with surgical assist devices, atrial septostomy, or extracorporeal membrane oxygenation. This study explored the hemodynamic effect associated with a percutaneous RV support device (pRVSD) for MR-RVF.

Methods: Between 2008 and 2010, 9 patients with MR-RVF, defined as cardiogenic shock despite maximal medical therapy, were treated with a pRVSD.

Subacute left ventricular rupture supported with a percutaneous left ventricular assist device.

Cardiac rupture is a fatal complication of transmural myocardial infarction that is associated with high mortality. We describe the successful management of a case of subacute cardiac rupture and cardiogenic shock supported by a percutaneous left ventricular assist device (LVAD) as a bridge to surgery.

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.

Orbital atherectomy for symptomatic lower extremity disease.

Background: Plaque-debulking technologies have been proposed as alternative treatment options for peripheral arterial disease. Orbital atherectomy (OA), using the DiamondBack360 device, has emerged as one promising modality.

Methods: We evaluated the safety and efficacy of OA in the first 200 lesions treated at our institution.

Transradial approach to lower extremity interventions.

Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of post-procedural bleeding complications and its impact on short- and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach.

Transradial approach to subclavian artery stenting.

Background: Subclavian artery angioplasty has been traditionally performed via the transfemoral approach. Transradial access is becoming increasingly used for coronary as well as for certain peripheral vascular beds. We describe our experience with transradial access for subclavian artery stenting.

Clinical practice guidelines and performance indicators as related--but often misunderstood--tools.

Background: Widespread variation in medical practice indicates that existing scientific evidence is often not translated into appropriate clinical care. Two tools have evolved that try to address this variation: clinical practice guidelines (CPGs) and performance indicators (PIs).

Tensions Between Cpgs And Pis: CPGs present available evidence that is subsequently reviewed and frequently adopted by professional organizations, so that clinicians may judge whether specific management recommendations are appropriate for each patient.