| Percutaneous revascularization has been used for the treatment of post-coronary bypass graft ischemia. This report illustrates the use of emergency left main coronary artery stenting in protected left main on the first post-operative day for management of perioperative coronary artery bypass graft surgery ischemia. ( info) |
2/135. 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. ( info) |
3/135. Successful balloon angioplasty of in-stent restenosis of left internal mammary artery. The development of disease in left internal mammary artery bypass grafts is uncommon. Furthermore, development of restenosis following successful angioplasty is very low. We report a patient with in-stent restenosis of left internal mammary graft treated successfully by balloon dilatation. ( info) |
4/135. Use of the multifunction probing catheter as an adjunctive device for occluded vein graft intervention. We describe the use of the multifunction probing catheter (Schneider, Bulach, switzerland) as an adjunct to conventional techniques in the treatment of a recent vein graft occlusion by thrombus, in order to highlight a possible further use for this device. ( info) |
5/135. Abnormal stress echocardiography results after coronary stenting. In a patient with a recently placed stent, a stress echocardiogram clearly indicated ischemia in the territory of the stented vessel. Subsequent coronary angiography, undertaken because of presumed restenosis, showed the stented area to be widely patent. This prompted a review of stress echocardiograms performed in patients within 6 weeks of coronary stenting. Of 21 such cases, 3 additional patients were found to have false-positive results in the territory served by the stented vessel. ( info) |
6/135. Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in brazil. Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment. ( info) |
| Three patients of ischemic heart disease associated with protein c deficiency are reported. Although delayed diagnosis of protein c deficiency resulted in the failure of repeated interventions, coronary artery bypass grafting performed after making the correct diagnosis has led to satisfactory mid-term results under strict anticoagulation therapy. The level of protein C should be measured more frequently in the field of ischemic heart disease and earlier diagnosis of its deficiency should be made, because measurement of protein C does not cost much. ( info) |
8/135. Rotational atherectomy of a stent-jailed septal perforator: a good verdict for the prisoner. A 61-year-old man is described, in whom percutaneous coronary intervention was done to treat critical ostial stenosis of the first and second septal perforators. The first branch originated from the stented portion of a previously treated left anterior descending artery, while the second branch was distal to the stent. During balloon angioplasty, the balloon catheter could not be delivered to the lesion site in the first branch, although the second branch was easily amenable to balloon dilatation. Rotational atherectomy was done to treat the former. Besides advocating rotational atherectomy as a novel strategy for managing jailed septal perforators, the case presents an insight into the vastly differing interventional situations of stent-jailed branch vis-a-vis de novo branch ostial stenosis. ( info) |
9/135. Angiogenesis, vascular endothelial growth factor and platelet-derived growth factor-BB expression, iron deposition, and oxidation-specific epitopes in stented human coronary arteries. Pathogenesis of in-stent restenosis remains poorly understood because information from human histopathologic studies is scarce. We used an improved saw-grinding and cutting method on methacrylate-embedded samples containing metal stents, which allows in situ hybridization and immunohistochemical analysis of in-stent restenosis. Twenty-one samples were collected 3 hours to 3 years after stenting from 6 patients aged 36 to 81 years. Except in very early samples collected within hours after the stent deployment, neovascularization was present in all segments studied. At advanced stages, extensive neovascularization was located mainly at the luminal side of the stent struts and was only rarely accompanied by inflammatory cells. The neovessels colocalized with vascular endothelial growth factor (VEGF)-A mRNA and protein expression as well as with iron deposits and oxidation-specific epitopes, which imply the presence of chronic oxidative stress. VEGF-A expression was detected in the same areas containing macrophages, endothelial cells, and, to a lesser extent, smooth muscle cells, which also showed platelet-derived growth factor-BB expression. We conclude that in-stent restenosis features neovascularization, VEGF-A and platelet-derived growth factor-BB expression, and iron deposition, which is most probably derived from microhemorrhages. These mechanisms may play an important role in the development of neointimal thickening and could provide useful targets for the prevention and treatment of in-stent restenosis. ( info) |
| Abciximab, heparin, and clopidogrel are often used together in the setting of coronary syndromes. These drugs are associated with thrombocytopenia and it is important to quickly discriminate the cause of this complication as it has implications for the management of thrombocytopenia and the coronary syndrome. This case highlights some of the dilemmas that may arise as no test can definitively identify the offending drug, and stopping these drugs can affect the outcome of the coronary event including stent thrombosis. ( info) |