Primary percutaneous coronary intervention and bleeding risk in the era of drug-eluting stent: a long-term cohort study.

Data of long-term efficacy and safety including bleeding risk associated with antithrombotic regimens after primary percutaneous coronary intervention (PCI) using first-generation drug-eluting stent (1st DES) are scarce. Consecutive 422 patients with ST-elevation myocardial infarction (STEMI) underwent primary PCI with DES (285 patients), bare metal stent (BMS, 58 patients) or balloon angioplasty (BA 79 patients). At a median follow-up of 44 months, major cardiovascular events were significantly lower for 1st DES compared with BMS and BA (11.

Treating coil migration in combination therapy involving stenting and coiling for a wide-necked renal aneurysm.

A man with a wide-necked renal artery aneurysm underwent combination therapy involving stenting and coiling to embolize it. However, a large section of one of the coils had migrated outside the stent implanted across the orifice of the aneurysm. After repositioning the migrated coil inside the stent, the implantation of another stent together with sandwiching of the coil between two stents repaired the prolapsed coil.

Two-wire protection of side branches to prevent side branch occlusion during stent implantation for bifurcational lesions.

To prevent side branch occlusion during bifurcational lesion stenting, the placement of a wire in both the main branch and side branch is performed for "side-branch protection". However, this procedure does not always prevent side branch occlusion. A procedure for placing two wires in the side branch, called "two-wire protection of side branches", is considered to be more likely to prevent occlusion compared with one-wire protection of the side branch.

Coronary vasospasm triggered ventricular fibrillation delayed after radiofrequency ablation of the right accessory pathway.

Ventricular fibrillation associated with coronary vasospasm developed 8 h after successful radiofrequency (RF) ablation of the right accessory pathway in an 81-year-old male. A segment of the coronary vasospasm was located close to the accessory pathway, where seven RF ablations had been applied. Although rare, physicians should carefully consider the risk of such events when an RF current is applied near a coronary artery.

Improved cardiac function after sirolimus-eluting stent placement in diabetic patients by pioglitazone: combination therapy with statin.

Background: Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists are used as anti-diabetic drugs, and their pleiotrophic action has been reported to improve endothelial function leading to cardioprotective effects. In this study we evaluated the long-term effect of pioglitazone on cardiac function in diabetic patients after percutaneous coronary intervention (PCI) by drug-eluting stent (DES).

Methods And Results: We investigated 54 diabetic patients who received PCI using a sirolimus-eluting stent.

Effect of cibenzoline and atenolol administration on dynamic left ventricular obstruction due to sigmoid-shaped septum.

Obstruction of the left ventricular outflow tract (LVOT) is usually complicated by hypertrophic cardiomyopathy or left ventricular hypertrophy. It occurs rarely in cases of sigmoid-shaped septum (SS), which are considered as a normal part of the aging process. The 2 cases of SS with obstruction of the LVOT were observed.

A case of intracoronary protruded thrombus caused after bailout stenting for side branch occlusion.

A 69-year-old woman underwent percutaneous coronary intervention for a severe stenotic lesion in the bifurcation of the mid-left anterior descending artery and first diagonal branch. A single stent was implanted into the left anterior descending artery. After the stent strut was dilated by balloon inflation in the diagonal branch, dissection occurred at the ostium of the diagonal branch and resulted in side branch occlusion due to hematoma.

Dynamic intraventricular obstruction in acute myocardial infarction with administration of cilostazol.

Dynamic intraventricular obstruction is a less well-known mechanical complication of acute myocardial infarction (AMI). Its hallmark is the development of a new systolic murmur, and echocardiography is necessary for diagnosis. We describe a case of a 74-year-old woman with dynamic intraventricular obstruction complicating AMI.

Guidewire-induced coronary artery perforation treated with transcatheter delivery of subcutaneous tissue.

In three cases of small coronary artery perforation by guidewires during percutaneous coronary intervention, coronary leakage continued despite prolonged balloon inflation and reversal of heparin. Subcutaneous tissue was selectively delivered to perforated vessels by means of microcatheters in a successful attempt to stop leakage. This method appears to be extremely effective for treating guidewire-induced perforations of distal coronary arteries.

Endovascular stent-grafting for recurrent aneurysm in Behcet's disease.

Arterial aneurysms represent a severe complication of Behcet's disease. A 42-year-old woman with Behcet's disease had a recurrence of an aneurysm after two surgical repair attempts using grafts. A covered stent-graft was implanted in her iliac external artery to occlude the neck of the aneurysm at the anastomosis of the bypass graft to her external iliac artery.

Aortocoronary dissection resolved by coronary stenting guided by intracoronary ultrasound.

Percutaneous coronary intervention (PCI) was performed for chronic total occlusion of the proximal right coronary artery in a 70-year-old male with unstable angina. The forceful manipulation of the guide catheter led to an aortocoronary dissection involving the right Valsalva sinus and the ascending aorta. Intracoronary ultrasound (ICUS) showed the important characteristics of the dissection, enabling successful coronary stenting under ICUS guidance.

Highly vascular pelvic tumor causing high-output heart failure because of massive arteriovenous shunting: a case report.

A 53-year-old Japanese woman underwent investigation of her heart murmur. A continuous abdominal bruit was heard. Blood gas analysis and chest X-ray showed congestive heart failure.