Iatrogenic left main coronary artery dissection and intramural hematoma caused by diagnostic transradial cardiac catheterization.

The growing use of the transradial approach for percutaneous coronary interventions has been shown to decrease the risk of major vascular complications. However, in this case report we describe a iatrogenic left main dissection during diagnostic coronary catheterization, which remains a rare, but still life-threatening condition. The adjunctive use of intravascular ultrasound may assist in the accurate diagnosis and treatment process.

Duty-cycled multi-electrode radiofrequency vs. conventional irrigated point-by-point radiofrequency ablation for recurrent atrial fibrillation: comparative 3-year data.

Aims: Pulmonary vein isolation (PVI) is an accepted treatment to relieve symptoms in patients with atrial fibrillation (AF). We studied 3 year outcome after PVI guided by duty-cycled multi-electrode radiofrequency (RF) ablation (pulmonary vein ablation catheter, PVAC) and provided comparative data to outcome after conventional PVI (CPVI) using mapping with irrigated, point-per-point RF ablation.

Methods And Results: One hundred and sixty-one consecutive patients with symptomatic paroxysmal or persistent AF and minimal heart disease underwent PVI (PVAC, n = 79 vs.

Early surgical repair of an acute post-infarction left ventricular pseudoaneurysm complicated by second pseudoaneurysm formation.

We present a case of an acute myocardial infarction complicated by an acute left ventricular pseudoaneurysm (LVPA). Surgical correction in the subacute phase was complicated by development of a second larger LVPA due to tearing of the sutures of the first surgical repair. Our case demonstrates the difficult decision-making regarding the timing of surgical intervention, which remains a debatable issue.

Left-sided high-flow arteriovenous hemodialysis fistula combined with a persistent left superior vena cava causing coronary sinus dilatation.

We present an interesting case illustrating the possible hemodynamic consequences when a left-sided arteriovenous hemodialysis fistula is combined with the congenital anomaly of a persistent left superior vena cava (PLSVC). Our case illustrates the importance of an echocardiographic examination with attention to the coronary sinus (CS) caliber-raising suspicion of a PLSVC-in the assessment for the hemodialysis access in end-stage renal disease patients. The causes and symptoms of CS dilatation, as well as the literature on PLSVC, are also discussed in detail.

Impact of radiofrequency characteristics on acute pulmonary vein reconnection and clinical outcome after PVAC ablation.

Objective: The objective was to study the impact of radiofrequency (RF) characteristics on acute pulmonary vein reconnection (PVR) and outcome after PVAC ablation. PVI with additional ablation of PVR (PVI + PVR) was compared to PVI-only.

Methods: In 40 consecutive patients, after PVAC-guided PVI, adenosine and a 1-hour waiting time were used to unmask and ablate acute PVR (PVI + PVR group).

Sequelae after AF ablation: Efficacy and Safety go Hand in Hand.

Although nowadays performed on a routine basis, catheter ablation of atrial fibrillation is associated with the potential for major complications. Improving the safety remains therefore an important challenge. This article summarizes the different types of complications associated with AF ablation grouping them into clinically overt major complications, subclinical injury and permanent injury.

Pulmonary vein isolation with the 30 and 35 mm high-density mesh ablator.

Aims: To analyse procedural results and clinical outcome of paroxysmal atrial fibrillation (AF) ablation using the 30 and 35 mm high-density mesh ablator (HDMA, Bard Electrophysiology).

Methods And Results: Sixty-four consecutive patients were ablated with the HDMA catheter (26 with the 30 mm, 38 with the 35 mm device). If pulmonary vein (PV) isolation was unsuccessful, ablation was continued using a conventional 4 mm ablation catheter.

Late renal stent thrombosis.

A patient with previous implantation of two stents in the left renal artery (because of refractory arterial hypertension) developed, 7 months after implantation, a renal infarction due to late renal stent thrombosis. The early diagnosis by means of computed tomography of the abdomen and the rapid intervention by means of percutaneous balloon angioplasty lead to a favorable outcome.

Changing the guiding catheter over the coronary wire: a simple (and cheap) technique to get out of trouble.

During acute myocardial infarction (MI), the culprit lesion is usually composed of thrombus and soft plaque. Sometimes, calcification can be present. A patient with acute MI, due to sub-occlusion of the ostial right coronary artery, underwent primary percutaneous intervention.

First report on the use of a novel self-expandable stent for treatment of ST elevation myocardial infarction.

A 69-year-old female underwent primary percutaneous coronary intervention with a Stentys self-expandable stent. Potential benefits of this stent are less intimal proliferation, reduced need for predilatation, reduced risk of malapposition and distal embolization. After written informed consent, the occluded proximal left anterior descending artery was successfully treated with thrombosuction, followed by implantation of the self-expandable stent.

The GENESIS (Randomized, Multicenter Study of the Pimecrolimus-Eluting and Pimecrolimus/Paclitaxel-Eluting Coronary Stent System in Patients with De Novo Lesions of the Native Coronary Arteries) trial.

Objectives: The aim of this study was to compare, in a randomized multicenter trial, paclitaxel-eluting stents (CoStar, Conor Medsystems, Menlo Park, California) versus pimecrolimus-eluting stents (Corio, Conor Medsystems) versus stents with dual elution of both drugs (SymBio, Conor Medsystems) in native coronary arteries.

Background: The CoStar cobalt-chromium reservoir-based stent platform, eluting paclitaxel in a controlled way via a bioresorbable polymer, reduces restenosis versus its respective bare-metal stent. The reservoir system allows the use of other drugs targeted to different mechanisms involved in the process of vascular restenosis and simultaneous loading of multiple, synergistic drugs.

Re-examining minimal luminal diameter relocation and quantitative coronary angiography--intravascular ultrasound correlations in stented saphenous vein grafts: methodological insights from the randomised RRISC trial.

Aims: Angiographic parameters (such as late luminal loss) are common endpoints in drug-eluting stent trials, but their correlation with the neointimal process and their reliability in predicting restenosis are debated.

Methods And Results: Using quantitative coronary angiography (QCA) data (49 bare metal stent and 44 sirolimus-eluting stent lesions) and intravascular ultrasound (IVUS) data (39 bare metal stent and 34 sirolimus-eluting stent lesions) from the randomised Reduction of Restenosis In Saphenous vein grafts with Cypher stent (RRISC) trial, we analysed the "relocation phenomenon" of QCA-based in-stent minimal luminal diameter (MLD) between post-procedure and follow-up and we correlated QCA-based and IVUS-based restenotic parameters in stented saphenous vein grafts. We expected the presence of MLD relocation for low late loss values, as MLD can "migrate" along the stent if minimal re-narrowing occurs, while we anticipated follow-up MLD to be located close to post-procedural MLD position for higher late loss.

9-month clinical, angiographic, and intravascular ultrasound results of a prospective evaluation of the Axxess self-expanding biolimus A9-eluting stent in coronary bifurcation lesions: the DIVERGE (Drug-Eluting Stent Intervention for Treating Side Branches Effectively) study.

Objectives: This study sought to assess the safety and performance of the Axxess (Devax Inc., Lake Forest, California) self-expanding drug-eluting stent in coronary bifurcation lesions.

Background: Percutaneous treatment of coronary bifurcations is a predictor of adverse late outcomes, in part because of the lack of dedicated devices.

Novel self-expanding stent system for enhanced provisional bifurcation stenting: Examination by StentBoost and intravascular ultrasound.

A 62-year-old man underwent percutaneous coronary intervention of a bifurcation lesion (Medina type 010) involving the mid-left anterior descending coronary artery and an important first diagonal branch with a novel stent specifically designed for bifurcations, the Stentys coronary bifurcation system. This is a self-expanding nitinol stent, with Z-shaped struts linked by interconnections that can be disconnected (in prespecified points every 1.5 mm all around the circumference and the length of the stent) at the level of the ostium of the side branch, simply by inflating an angioplasty balloon tracked to the ostium of the side branch, through the stent struts.

Step-by-step StentBoost-guided small vessel stenting using the self-expandable Sparrow stent-in-wire.

A 56 year-old woman underwent percutaneous coronary intervention for a lesion in a small mid-left anterior descending coronary artery (reference vessel diameter by quantitative coronary angiography: 2.11 mm) with a novel drug-eluting stent specifically designed for small vessels, the CardioMind Sparrow stent delivery system. This is a self-expandable sirolimus-eluting nitinol stent directly mounted into a 0.

Comparison of assessment of native coronary arteries by standard versus three-dimensional coronary angiography.

Vessel foreshortening is a major limitation of standard coronary angiography due to the 2-dimensional representation of 3-dimensional structures. Three-dimensional models may overcome it. The aim of this study was to compare measurements of coronary segments from quantitative coronary angiography (QCA) in an operator-selected "working view" of standard 2-dimensional coronary angiography with those from 3-dimensional coronary angiography (3D-CA) reconstruction models, which are automatically generated from software applied to rotational coronary angiographic acquisitions.

Percutaneous treatment of diseased saphenous vein grafts: current state-of-the-art and future directions.

The percutaneous treatment of patients with obstructive atherosclerotic disease in diseased coronary saphenous vein bypass grafts still remains a challenge in interventional cardiology. We discuss the actual evidence-based knowledge for the percutaneous management of this lesion subset, focusing on the devices that are actually considered the gold standard for this treatment: bare-metal stents and distal protection devices. We also comment the negative results of the trials regarding the promising covered stent-grafts.

Increased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts: results from the randomized DELAYED RRISC Trial.

Objectives: We sought to provide long-term follow-up data of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVG) from the RRISC (Reduction of Restenosis In Saphenous vein grafts with Cypher) trial.

Background: We have previously shown that, in SVG, the use of SES reduces 6-month restenosis and repeated revascularization procedures versus the use of BMS. These data are consistent with trials in native coronary arteries.

Intravascular ultrasound comparison of sirolimus-eluting stent versus bare metal stent implantation in diseased saphenous vein grafts (from the RRISC [Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent] trial).

The randomized Reduction of Restenosis In Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent trial compared angiographic outcomes of sirolimus-eluting stents (SESs) versus bare metal stents (BMSs) in saphenous vein grafts (SVG). Using intravascular ultrasound (IVUS) performed during 6-month follow-up angiography, we compared the vascular effects of the 2 types of stent on SVGs. Of 75 patients (96 lesions) included, 59 patients underwent IVUS in 61 SVGs; 29 patients received 40 SESs for 34 lesions, and 30 patients received 42 BMSs for 39 lesions.

Bifurcation stenting with a dedicated biolimus-eluting stent: X-ray visual enhancement of the final angiographic result with "StentBoost Subtract".

A 51 year-old man underwent percutaneous coronary intervention of a significant "true" bifurcation lesion involving the proximal left anterior descendens (LAD) artery and an important first diagonal branch with a dedicated bifurcation stent, which is a conical self-expandable biolimus-eluting stent with a "flared" distal part allowing for optimal scaffolding of the carina of the bifurcation, and two additional sirolimus-eluting stents, deployed with the V-stenting technique, one in the LAD and one in the diagonal branch, in overlap with the distal part of the "flared" biolimus-eluting stent. An X-ray enhancing visualization technique, "StentBoost Subtract," was used to obtain an improved visualization of the stent in relation to the corresponding vessel lumen and revealed good expansion of all the stents and good apposition to the vessel wall.

Selective clearance of macrophages in atherosclerotic plaques by autophagy.

Objectives: The purpose of this study was to investigate whether stent-based delivery of an inhibitor of mammalian target of rapamycin (mTOR) can selectively clear macrophages in rabbit atherosclerotic plaques.

Background: Current pharmacologic approaches to stabilize atherosclerotic plaques have only partially reduced the incidence of acute coronary syndromes and sudden death. Macrophages play a pivotal role in plaque destabilization, whereas smooth muscle cells (SMC) promote plaque stability.

Acute and mid-term local vascular effects of compliant balloon inflation (GuardWire system) on saphenous vein bypass grafts: an angiographic analysis.

Background: The GuardWire distal protection device reduces the incidence of periprocedural complications during percutaneous stenting of diseased saphenous vein grafts. Its mechanism of action is based on the occlusion of the vessel distal to the lesion with an inflated compliant balloon before the intervention, and the aspiration of embolized material after stent implantation. Although no safety issues related to the compliant balloon have been reported in vein graft treatment, concerns related to the potential injury of the balloon on the vessel wall have been raised.

Randomized double-blind comparison of sirolimus-eluting stent versus bare-metal stent implantation in diseased saphenous vein grafts: six-month angiographic, intravascular ultrasound, and clinical follow-up of the RRISC Trial.

Objectives: We sought to compare, in a randomized fashion, sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVGs).

Background: Sirolimus-eluting stents reduce restenosis and repeated revascularization in native coronary arteries compared with BMS. However, randomized data in SVG are absent.