Case of paradoxical embolic transient ischemic attack from an unusual extra cardiac shunt detected on a contrast-enhanced echocardiogram.

Paradoxical embolism due to extracardiac right to left shunts (RLSs) manifesting as stroke remains anecdotal. We describe a case of 63-year-old female who presented with a transient ischemic attack and at agitated saline contrast echocardiogram was found to have an unusual type of an extracardiac RLS. Further evaluation leads to diagnosis of superior vena cava (SVC) thrombosis from a prior indwelling central venous catheter.

RX Herculink Elite(®) renal stent system: a review of its use for the treatment of renal artery stenosis.

The management of renal artery stenosis (RAS) remains controversial. While some evidence suggests that treatment with stent placement is beneficial, randomized trials have failed to demonstrate a significant benefit. Ongoing clinical trials should help to better define the role for stenting of RAS while avoiding limitations seen with earlier trials.

Renal artery stenosis: optimizing diagnosis and treatment.

Renal artery stenosis (RAS) is the most commonly caused by atherosclerosis, with fibromuscular dysplasia being the most frequent among other less common etiologies. A high index of suspicion based on clinical features is essential for diagnosis. Revascularization strategies are currently a topic of discussion and debate.

Impact of an acute coronary syndrome pathway in achieving target heart rate and utilization of evidence-based doses of beta-blockers.

Beta-blockers remain a cornerstone of therapy in the management of acute coronary syndrome (ACS). The 2007 American College of Cardiology/American Heart Association unstable angina/non-ST elevation myocardial infarction guideline revisions recommend a target heart rate (HR) of 50-60 beats per minute (bpm). Despite improved trends toward utilization of beta-blockers therapy, beta-blockers continue to be underdosed.

Management of renal artery stenosis: 2010.

Renal artery stenosis (RAS) is a relatively common manifestation of atherosclerosis, although in a small percentage of cases it is due to fibromuscular dysplasia and less frequently may have other etiologies. RAS may be treated by revascularization, using either percutaneous or open surgical techniques. Currently, technical success with percutaneous revascularization utilizing angioplasty and stenting is achieved in 95% or more of cases in which it is attempted.

Spontaneous coronary artery dissection: to treat or not to treat--2 atypical cases and a review of the literature.

Spontaneous coronary dissection is an unusual cause of acute coronary syndrome and sudden death, with a predilection for otherwise healthy young women. Presentation during the peri-partum period accounts for a quarter of the cases. We describe 2 cases of spontaneous coronary dissection with some atypical features.

Acute mitral regurgitation after acute myocardial infarction in a patient with a patent foramen ovale: review of the diagnosis and management of acute ischemic mitral regurgitation.

We discuss the diagnosis and the management of a 78 year old woman who devoloped acute ischemic mitral regurgitation as a result of ruptured anterior chordal structures of the mitral valve. The patient in addition had a patent formen ovale.

Predictors of embolization during protected renal artery angioplasty and stenting: Role of antiplatelet therapy.

Objective: The objective of this study was to identify the predictors of distal embolization (DE) during protected renal artery angioplasty and stenting.

Background: DE may contribute to worsening renal function after renal artery stenting. The factors associated with DE, rates of platelet-rich emboli, and treatments that may prevent DE during renal stenting have not been evaluated.

Stroke in a patient with a surgically ligated left atrial appendage: should warfarin be continued after left atrial appendage ligation?

We report on a 74-year-old woman who presented with embolic stroke of the brainstem and right cerebellum. She had undergone coronary bypass surgery and prophylactic ligation of the left atrial appendage in the past. On further investigations, a source of emboli was found to be an incompletely ligated left atrial appendage.

Cardiovascular morbidity and mortality and renal artery stenosis.

Renal artery stenosis (RAS) is a common manifestation of atherosclerosis and is associated with many other atherosclerotic conditions. Cardiovascular morbidity and mortality is increased among patients with RAS. This increase is likely due in part to the associated disease states; however, RAS itself may also contribute.

A retrospective analysis and case series of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage: two case reports.

Introduction: Glycoprotein IIb/IIIa inhibitors have a key role in the treatment of patients with acute coronary syndromes undergoing percutaneous interventions. Although, an increased risk of bleeding complications is well recognized, its association with diffuse alveolar hemorrhage is much less recognized. Previous authors have suggested that the incidence of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage has been significantly underestimated due to under reporting.

Common femoral artery access techniques: a review.

The increasing burden of coronary artery disease has resulted in more percutaneous coronary artery interventions. The common femoral artery remains the most widely accepted site for percutaneous coronary artery access. Local access site, vascular complications remain a considerable source of morbidity during common femoral arterial puncture.

Pneumopericardial tamponade resulting from a spontaneous gastropericardial fistula.

Pneumopericardium is a rare but serious cause of morbidity and mortality. Untreated, it can lead to cardiac tamponade and thus must be promptly identified to treat the underlying etiology. Here, we report a case of spontaneous pneumopericardium secondary to gastric ulcer perforation in association with a hiatal hernia.

Complete versus partial distal embolic protection during renal artery stenting.

Objective: The aim of this study was to evaluate whether complete embolic protection is superior to partial embolic protection for preservation of kidney function during renal artery angioplasty and stenting.

Background: Renal artery angioplasty and stenting (RAAS) is a common treatment for atherosclerotic renal artery stenosis. However, RAAS may be complicated by peri-procedural loss of kidney function.

Renal insufficiency as a predictor of adverse events and mortality after renal artery stent placement.

Background: Renal artery stenosis (RAS) is associated with substantial morbidity and mortality. This relationship is strongest in the presence of renal insufficiency (RI). The goal of this study is to assess the relationship between RI, mortality, and adverse events in the setting of renovascular disease.

Compliance with antihypertensive therapy after renal artery stenting.

Hypertension is an important clinical endpoint after renal artery revascularization for renal artery stenosis (RAS). Medication compliance is a critical determinant of blood pressure control. Although factors influencing compliance are known in essential hypertension, they have not been evaluated in studies investigating renal artery revascularization.

Utility of a 0.014" pressure-sensing guidewire to assess renal artery translesional systolic pressure gradients.

Renal ischemia due to renal artery stenosis (RAS) is an important cause of secondary hypertension and renal insufficiency. Several methods are available to diagnose RAS; however, the identification of clinically significant lesions remains problematic. We measured the translesional systolic pressure gradient (TSPG) with a 4 Fr catheter and a 0.

Intra-aortic balloon pump placement following aorto-iliac angioplasty and stent placement.

Approximately 20% of patients are unable to receive an intra-aortic balloon pump (IABP) due to aorto-iliac atherosclerotic disease. Aorto-iliac stenoses can be managed with angioplasty or stent placement; however, there are limited data about this strategy to facilitate IABP placement. Thirty-seven IABPs were placed in 35 patients.