1/21. Iatrogenic left anterior descending artery stenosis in response to the nose cone of a directional atherectomy device: a different sort of restenosis.Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is well described and refers to the development of a significant narrowing at the site of the lesion treated. A case is reported of a female patient who underwent directional coronary atherectomy (DCA) and stent insertion at the origin of the left anterior descending artery. This was performed without complication. Repeat angiography was performed because of return of angina after ten weeks; it demonstrated a widely patent stent, but also a significant stenosis distal to the stent where the nose cone of the DCA device had been positioned. This stenosis was successfully stented. The patient remains well at follow-up.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
2/21. Non-flow limiting dissection leading to late coronary restenosis following intracoronary brachytherapy.We report a coronary dissection detected during routine repeat angiography 6 months following balloon angioplasty and intracoronary radiation. No dissection was seen immediately following the initial procedure. Subsequent late healing of the dissection led to marked restenosis and the development of angina 14 months after the index procedure.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
3/21. Treatment of a giant coronary aneurysm with a novel technique: scaffolding (tunnel) stenting to support PTFE-covered stents: insights from intravascular ultrasound.This report describes a patient with progressive angina and a giant coronary aneurysm in the right coronary artery. Percutaneous treatment was performed using a novel technique consisting of implantation of a long stent that provided scaffolding or bridge for the subsequent implantation of two polytetrafluoroethylene-covered stents. Complete closure of the aneurysm was successfully achieved. In the angiogram performed 3 months later for recurrent angina, a localized narrowing at the distal stent edge (corresponding to severe underexpansion of the stent struts on intravascular ultrasound) was observed. This was successfully treated with balloon angioplasty. The technical details of this new technique are described.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
4/21. coronary artery bypass grafting for a patient with tangier disease.A 56-year-old man with tangier disease suffering from angina pectoris due to triple-vessel coronary artery disease evidenced extremely low blood high-density lipoprotein of 1 mg/dl, a specific laboratory indicator of this rare genetic disorder of lipid metabolism, considered to accompany juvenile arteriosclerosis. Because of the calcified ascending aorta, we conducted combined minimally invasive coronary artery bypass (CAB) for the left anterior descending coronary artery and percutaneous transluminal coronary angioplasty for other coronary artery lesions initially instead of conventional coronary artery bypass grafting. Angina recurred, however, due to refractory restenosis of the left circumflex coronary artery lesion. Two years later, we redid the CAB, grafting the free right internal thoracic artery from the functional left internal thoracic artery sequentially onto obtuse marginal and posterolateral coronary arteries. The patient returned to work angina-free.- - - - - - - - - - ranking = 2keywords = angina (Clic here for more details about this article) |
5/21. Combination antiplatelet therapy: implications for pharmacists.OBJECTIVES: To present two case reports of patients who received suboptimal oral antiplatelet therapy and to review recent changes in national guidelines for management of acute coronary syndromes. DATA SOURCES: Personal observation by the authors, and clinical practice guidelines and related clinical trials of the american heart association and the American College of cardiology. SUMMARY: The American College of cardiology and the american heart association revised the guidelines for administration of antiplatelet and anticoagulant therapy in patients with unstable angina and non-ST-segment elevation myocardial infarction in March 2002. Two cases observed by the authors illustrate the consequences of suboptimal antiplatelet therapy when a combination of two antiplatelet drugs should have been administered. CONCLUSION: Evidence from recent randomized controlled trials led to changes in the national guidelines for administration of oral antiplatelet therapy in patients with acute coronary syndromes. pharmacists should be aware of these changes and counsel patients about appropriate administration of antiplatelet drugs.- - - - - - - - - - ranking = 1.0009530448327keywords = angina, stable (Clic here for more details about this article) |
6/21. Restenting for subclavian in-stent restenosis with symptomatic recurrent coronary-subclavian steal.PURPOSE: To determine whether restenting for recurrent coronary-subclavian syndrome is technically feasible, provides durable results, and is a reasonable alternative to surgery. CASE REPORT: A 58-year-old woman with a left internal mammary artery (LIMA) bypass to the left anterior descending artery underwent angioplasty and stent placement for left subclavian stenosis and coronary-subclavian steal. Twenty-three months later, she returned with progressive angina and left arm claudication; heart catheterization demonstrated restenosis of the subclavian artery at the stent site with recurrence of the coronary-subclavian steal. Successful redo angioplasty and stenting resulted in normal antegrade flow through the LIMA graft. The patient has remained asymptomatic for 3 years without evidence of recurrent in-stent stenosis on serial noninvasive studies. CONCLUSIONS: Restenting is technically feasible and appears to be a durable response to subclavian in-stent restenosis in patients with coronary subclavian steal.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
7/21. Takayasu's arteritis: management of left main stem stenosis.takayasu arteritis is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree, and needs to be considered in a young patient with angina, in particular when pulses are absent. This case illustrates the limitations of exercise testing in diagnosing the extent of coronary artery disease and the risks associated with coronary angiography in patients with inflammatory disease in the left main stem coronary artery. It also highlights the novel use of non-invasive scanning with positron emission tomography using 18-fluorodeoxyglucose in assessing remission from this disease. Revascularisation was performed with percutaneous transluminal coronary angioplasty and stenting as an emergency procedure, but treatment of the restenosis with directional atherectomy was based on a review of the available literature. The lymphocytic alveolitis seen in this patient has not been previously described in Takayasu's disease.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
8/21. Late thrombosis after gamma-brachytherapy.Late stent thrombosis (> 30 days after treatment) is a new phenomenon occurring after vascular brachytherapy. We report the analysis of 11 patients with late thrombosis after gamma-irradiation treatment of in-stent restenosis. All patients had in-stent restenosis and angina. Contributing factors to late thrombosis include long stents, small distal vessels, and complex lesion morphology.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
9/21. brachytherapy for refractory coronary artery restenosis.A 76-year-old female patient complained of progressive episodes of chest and left arm pain and numbness, accompanied by a burning sensation in the left breast. The symptoms were nitroglycerine-responsive and consistent with her prior angina. Cardiac history included an initial percutaneous coronary intervention and 4 subsequent occurrences of restenosis in a stented area of the left anterior descending (LAD) coronary artery. Following a fifth restenosis of the LAD, the Novoste Beta-Cath brachytherapy System was employed following balloon dilatation of the persistent recurrence. At 10 months post-brachytherapy, angiography revealed a patent LAD with no evidence of in-stent restenosis.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
10/21. Complex transradial three vessel brachytherapy in a single session.BACKGROUND: We report the case of a patient who underwent transradial brachytherapy in 3 different coronary vessels during a single session. She initially presented with unstable angina 4 months after the index procedure; control angiography showed severe and diffuse in-stent restenosis in the LAD, Cx and Mg arteries. methods: After successful dilatation of the three vessels, we performed vascular brachytherapy using the Novoste Beta-Rail system and a 60 mm length source train of 90Sr/Y radioactive seeds. No further stent was implanted. The patient left the hospital the next day. Follow-up angiography revealed widely patent vessels with no restenosis. CONCLUSION: Transradial multivessel brachytherapy can be done during the same session.- - - - - - - - - - ranking = 1.0009530448327keywords = angina, stable (Clic here for more details about this article) |
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