Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR).

Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-requiring diabetes mellitus (NIRDM), and newly identified DM (hemoglobin A1C level >6.5%) versus patients without DM are limited.

Use of the trellis device in the management of deep vein thrombosis: a retrospective single-center experience.

Objectives: The Trellis thrombectomy system (Covidien) is one of the newer devices that incorporates isolated pharmacomechanical thrombectomy and thrombolysis (PMT) for treatment of deep venous thrombosis (DVT). We conducted a retrospective review of patients with upper- and lower-extremity DVT managed with the Trellis thrombectomy system at our center.

Methods: All patients with symptomatic DVT who presented to our center between April 2010 and April 2011 who underwent PMT by the Trellis device were included in this retrospective review.

Isolated right ventricular infarction after modified Cabrol operation.

We report the case of a 27-year-old woman with a rare presentation of right ventricular failure secondary to isolated right ventricular myocardial infarction, 3 weeks after an uncommon surgical procedure, the modified Cabrol operation. Her medical history also included a Ross procedure at the age of 12 years. On the basis of her subacute presentation and a consultation with cardiac surgeons, we decided on medical management.

Use of a novel adjunctive kissing-balloon technique with the Trellis device to successfully prevent embolization across juxtaposed kissing aortoiliac stents.

The Trellis thrombectomy system (Covidien) has been used successfully to perform isolated pharmacomechanical thrombectomy of both venous and arterial thrombi. The device is designed to provide localized treatment while preventing both systemic spread of the thrombolytic agent and also distal embolization. However, when this device is utilized to remove thrombi at bifurcation lesions, embolization into the contralateral vessel can potentially occur.

Re-entry devices in the treatment of peripheral chronic occlusions.

Chronic occlusions are present in up to 40% of patients who undergo treatment for symptomatic peripheral arterial disease. The primary difficulty encountered during the treatment of chronic occlusions is inability to re-enter the true lumen after subintimal crossing of the occlusion. Two devices have been designed to mitigate this limitation via controlled re-entry.

Retrograde access via the popliteal artery to facilitate the re-entry technique for recalcitrant superficial femoral artery chronic total occlusions.

Subintimal recanalization is beneficial in selected patients with peripheral chronic total occlusions (CTO). However, in complex cases, re-entry into the true arterial lumen may prove to be unsuccessful with a conventional guidewire or a re-entry catheter when using standard femoral artery access. Our case series describes these technical dilemmas along with strategies that can be utilized to overcome these challenges.

Effect of statin therapy on contrast-induced nephropathy after coronary angiography: a meta-analysis.

Background: Although the pleiotropic effects of statins are postulated to be renoprotective, clinical studies have demonstrated conflicting results. We undertook a meta-analysis of published trials to evaluate the impact of statin therapy on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography.

Methods: We searched MEDLINE and EMBASE databases through December 2010 for articles evaluating the effect of statins on the incidence of CIN in patients undergoing coronary angiography.

Pharmacomechanical thrombolysis of acute and chronic symptomatic deep vein thrombosis: a systematic review of literature.

Pharmacomechanical thrombolysis (PMT) is an emerging treatment option for symptomatic deep vein thrombosis (DVT). This may obviate the need for systemic or catheter-directed thrombolysis. PubMed, EMBASE, and Cochrane database search of PMT in acute and chronic symptomatic DVT was undertaken.

Rapidly evolving coronary aneurysm in a patient with rheumatoid arthritis.

Coronary artery aneurysm (CAA) formation in the setting of an acute inflammatory state due to connective tissue disease is rare. We report a case of rapid progression from an ectatic to an aneursymatic left circumflex coronary artery leading to an acute coronary event in a patient with rheumatoid arthritis (RA). We report the accelerated growth of the aneurysm as it was temporally related to the lapse in treatment and the management strategies involved with this entity.

Acute stent thrombosis associated with heparin-induced thrombocytopenia and abciximab-induced profound thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a wellknown complication after exposure to heparin products. Profound thrombocytopenia has also been reported with the use of abciximab, a glycoprotein IIb/IIIa receptor antagonist, which is used during percutaneous coronary intervention. Acute stent thrombosis is a rare but serious complication of HIT.

AngioSculpt PTCA Balloon Catheter entrapment and detachment managed with stent jailing.

The AngioSculpt PTCA Scoring Balloon Catheter is an FDA-approved device for plaque modulation. We describe the first case of AngioSculpt EX catheter entrapment and detachment in the right coronary artery during PCI that was successfully managed with stent jailing of the entrapped balloon catheter and its shaft against the vessel wall.

Bifurcated aortic endograft limb occlusion managed with a novel method of isolated pharmacomechanical thrombectomy.

Limb occlusion of an aortic endograft is uncommon, however, it can result in permanent sequelae if management is delayed. We report the first case utilizing the Trellis device to achieve localized and prompt isolated pharmacomechanical thrombectomy (PMT) for the treatment of acute limb thrombosis of a bifurcated aortic endograft.

Isolated pharmacomechanical thrombectomy for the management of chronic DVT.

Thrombo-reduction in the setting of deep vein thrombosis (DVT) to prevent the postthrombotic syndrome has not been traditionally managed by interventional cardiologists. We report a case series of successful chronic DVT management with pharmacomechanical thrombectomy utilizing the Trellis device.

Giant splenic artery aneurysm: managed in the cardiovascular catheterization laboratory using the modified neck remodeling technique.

We report the first case of coil embolization using the "modified neck remodeling technique" in the management of a splenic artery aneurysm. This technique was feasible due to the unique and complex anatomy of the aneurysm. This condition has been largely treated by vascular surgeons and interventional radiologists; however, this patient was referred to the interventional cardiologists for endovascular coiling.

Activating autoantibodies to the beta-1 adrenergic and m2 muscarinic receptors facilitate atrial fibrillation in patients with Graves' hyperthyroidism.

Objectives: We studied activating autoantibodies to beta-1 adrenergic receptors (AAbeta1AR) and activating autoantibodies to M2 muscarinic receptors (AAM2R) in the genesis of atrial fibrillation (AF) in Graves' hyperthyroidism.

Background: Atrial fibrillation frequently complicates hyperthyroidism. Both AAbeta1AR and AAM2R have been described in some patients with dilated cardiomyopathy and AF.

Ureteroarterial fistula: a rare cause of hematuria managed in the cardiac cath lab.

Ureteroarterial fistulae (UAFs) are rare but potentially life-threatening entities that require a high degree of suspicion for diagnosis followed by prompt intervention. This case report describes the successful management of the oldest woman to-date presenting with intermittent hematuria, secondary to a fistula between the ureter and internal iliac artery, which was subsequently resolved by coil embolization. Morbidity and mortality associated with UAFs can be decreased by increasing awareness of this rare but fatal complication.

Anterolateral myocardial infarction induced by coronary-subclavian-vertebral steal syndrome successfully treated with stenting of the subclavian artery.

A female patient with graft-dependent coronary circulation presented with vertebrobasilar insufficiency and NSTEMI (Non-ST-Elevation Myocardial Infarction) related to a 100 percent stenosis of the left subclavian artery. Our review of the medical literature indicates that this is the first reported case in which a patient presented with an anterolateral NSTEMI and dizziness with subsequent angiographic evidence of both coronary subclavian and vertebral subclavian steal syndromes successfully treated with angioplasty and stenting of the left subclavian artery without any intervention in the coronary arterial tree.