Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial.

Aims: Thrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial (N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome.

Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations.

Background: The crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry.

A calcified neointima--"stent" within a stent.

De novo atherosclerosis arising within a coronary stent is rare and generally occurs many years after stent deployment. We describe a case of restenosis in a patient presenting with angina 8 years after original stent deployment. Intravascular ultrasound greyscale imaging and virtual histology demonstrated that this "neointima" was calcified.

Long-term outcomes after percutaneous coronary intervention of bifurcation narrowings.

The optimal approach to percutaneous coronary intervention (PCI) of bifurcation lesions remains unclear, reflecting lack of long-term follow-up and heterogeneity of lesions encountered. We evaluated the long-term outcome of patients undergoing bifurcation PCI followed in the prospective bifurcation registry at the University Health Network, Toronto, Ontario, Canada. Of 526 patients undergoing bifurcation PCI between November 2003 and March 2005, most (n = 406) were treated by main vessel stenting only (n = 266) or crush/culotte stenting (n = 140).

Prediction of distal embolization during percutaneous coronary intervention in saphenous vein grafts.

Distal protection devices have been proved to decrease distal embolization and improve outcome in unselected patients undergoing percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). However, it remains uncertain whether distal protection is necessary in all patients. We investigated whether clinical or angiographic variables can predict distal embolization and, hence, need for a distal protection device.

Predictors of long-term outcome after crush stenting of coronary bifurcation lesions: importance of the bifurcation angle.

Objectives: We hypothesized that the bifurcation angle (BA) may affect the outcome of crush stenting (CS) of bifurcation lesions and thus set out to determine the effect of the BA on outcome of patients undergoing coronary bifurcation CS.

Methods: Of 538 bifurcation PCI cases performed between November 2003 and March 2005, 133 were performed using CS (n = 56), balloon CS (n = 71), or reverse CS (n = 6). Patients were divided into low-angle and high-angle groups using the median BA as the cut point.

Predictors of angiographic restenosis after coronary intervention in patients with diabetes mellitus.

Background: Patients with diabetes mellitus are particularly prone to restenosis after percutaneous coronary intervention. An exploratory, nested, case-control study was undertaken to identify clinical, lesional, and procedural predictors of angiographic restenosis in these patients.

Methods: Seventy-five patients with diabetes mellitus with 86 coronary lesions were selected from a larger population of 217 patients who had undergone 6-month angiographic follow-up after a first, successful balloon angioplasty (PTCA) or stent implantation procedure.

The role of intravascular ultrasound in the diagnosis and treatment of patients with coronary artery disease.

Approximately 95% of the coronary vasculature is atherosclerotic before lesions are visible by coronary angiography. Intravascular ultrasound assesses the burden of coronary atherosclerosis, as well as clarifying the anatomical and physiological characteristics of ambiguous lesions.