Catheterization and Cardiovascular Diagnosis

No abstract text is available yet for this article.

The Bard XT stent is a new generation balloon expandable intracoronary stent. It has several unique design advantages. Between October 1996 and November 1997, 127 Bard XT stents of various length were deployed in 93 patients with 109 lesions. According to the American College of Cardiology (ACC) and American Heart Association (AHA) classifications 7 lesions were type A, 38 were type B1, 43 were type B2 and 21 were type C [Ellis et al.: Circulation 82:1193-1202, 1990]. Stent delivery was successful in 98% of attempts...

No abstract text is available yet for this article.

Side-branches often complicate stenting of coronary lesions. We investigated a new stent, characterized by four wider cells in its center, which can be expanded up to 3.5 mm and which are meant to be placed over the ostium of a major side-branch. Forty-seven consecutive patients with lesions involving 48 side-branches received one side-branch stent each. Stent deployment was successful in all patients. Twenty-five side-branches needed additional treatment. Nineteen side-branches received a PTCA, and 6 additional side-branches were stented...

No abstract text is available yet for this article.

Optimization of dose and image quality is task-dependent. The three main image quality parameters, sharpness, contrast, and noise, are interdependent in radiographic systems. The need to minimize patient dose imposes further couplings between these factors. This is the reason why there are no universally applicable imaging systems.

Renal artery stenosis involving the renal artery ostium often responds suboptimally to balloon angioplasty. In this context, immediate and long-term results can be optimized by stenting. Occasionally, lesions may involve the midartery segment at a branch point. We report a case of a bifurcation lesion which responded poorly to balloon angioplasty despite the kissing balloon technique. Excellent angiographic result was finally achieved by deploying two flexible coil stents in a "kissing" fashion. The patient's hypertension came under control overnight...

Intraarterial injection of absolute ethanol was employed for the management of a pseudoaneurysm following percutaneous nephrolithotomy. The ethanol was delivered selectively using a coronary angioplasty catheter. This seems to be a potentially useful method for the management of severe hematuria following percutaneous renal procedures.

Pharmacological therapy remains the treatment of choice for Prinzmetal angina. We report an unconventional approach of coronary artery stenting to treat coronary artery spasm in variant angina refractory to triple drug therapy. Favorable clinical and angiographic results and a negative Ergonovine test, under less aggressive medical therapy, are valuable arguments for stenting. Four-month angiographic follow-up showed absence of intrastent restenosis with a negative Ergonovine test. However, long-term follow-up is necessary before advocating this as a systematic approach...

The management of high-grade stenosis involving the petrosal segment of the internal carotid artery has been limited to angioplasty alone in the past. However, if angioplasty fails or has less than optimum results, then endovascular stent placement should be considered. We present the first two known cases in which the Multi-Link coronary stent was used for the treatment of internal carotid disease in the petrosal segment. The first patient had symptomatic stenosis that failed angioplasty after seven months and the second patient had a symptomatic lesion that dissected upon angioplasty...

We describe a case of essential thrombocythemia in a 34-year-old male who presented with acute anterior wall myocardial infarction and a platelet count of 2,100,000/mm3. Primary percutaneous coronary angioplasty and stenting were performed. Postangioplasty course was complicated by stent thrombosis requiring repeat coronary angioplasty and persistent femoral arterial bleeding that was treated with surgical exploration and repair. The patient was subsequently treated with platelet pheresis, acetylsalicylic acid, ticlopidine, hydroxyurea, and anagrelide without further complications...

No abstract text is available yet for this article.

We describe the use of the Inoue balloon to dilate the aortic valve by the physiologic antegrade route during pregnancy. A 27-year-old pregnant woman with severe aortic stenosis presented with progressive dyspnea and presyncope at 26 weeks of pregnancy. She subsequently underwent percutaneous valvuloplasty by the antegrade route utilizing the transseptal puncture. We conclude that percutaneous antegrade balloon valvuloplasty by the Inoue balloon (venous approach) is a safe and effective procedure. It markedly reduces fluoroscopy and is a palliative procedure that allows pregnancy to continue...

No abstract text is available yet for this article.

Coronary perforation can be managed with prolonged balloon inflations, covered stents, or embolization of the vessel. We report on a case of a balloon-induced perforation of the distal left anterior descending artery, that was sealed by injecting preclotted autologous blood through the balloon catheter lumen at the site of the perforation. The patency of the distal vessel was maintained.

No abstract text is available yet for this article.

We report a patient who underwent resection of a mediastinal tumor with postoperative irradiation. Cardiac catheterization fifteen years later demonstrated coronary artery-pulmonary artery fistulas from both the right and left coronary arteries. This case report raises the issue of whether external beam irradiation may have been integral in neovascularization and the development of this acquired abnormality.

We report an infant with a large patent ductus arteriosus (PDA) and a hypoplastic aortic isthmus presenting with factitious coarctation due to high ductal flow. Following transcatheter occlusion of the PDA with a Gianturco-Grifka vascular occluder, the aortic gradient resolved, thereby eliminating the need for surgery on the isthmus.

Two babies with duct-dependent cyanotic congenital heart disease were palliated with modified Blalock-Taussig shunts. One patient was diagnosed to have tetralogy of Fallot, and the other patient, tricuspid atresia type Ia. Early postoperative arterial oxygen saturations dropped significantly due to shunt thrombosis. Both patients were successfully treated with angioplasty and stent implantation.

The radial artery is being used with increasing frequency to replace the saphenous vein as a coronary artery bypass graft, in the belief that it will provide improved long-term patency. Several centers have confirmed that the early results of surgery using the radial artery seem to be better than those obtained with saphenous grafts. Despite these apparent gains, early failure of the radial artery graft can occur and is frequently associated with symptomatic myocardial ischemia. Percutaneous angioplasty is an alternative to reoperation to treat lesions occurring on radial artery grafts...