Dual antiplatelet therapy with aspirin and clopidogrel is the standard of care for patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary intervention (PCI). It is well established that inhibition of platelet aggregation reduces the risk of recurrent thrombotic events and stent thrombosis. However, some patients show a reduced antiplatelet response to standard clopidogrel loading (300 mg) and maintenance (75 mg day−1) doses, which has been associated with poorer patient outcomes. Pharmacodynamic and pharmacokinetic studies show that higher-than-standard clopidogrel dosing strategies facilitate more rapid platelet inhibition of a greater intensity as a result of greater plasma concentrations of the clopidogrel active metabolite. Recently completed studies suggest that in patients with ACS undergoing PCI, higher-than-standard clopidogrel dosing regimens provide greater inhibition of platelet function and improved clinical outcomes with a small but significant increase in major bleeding. Newer, more potent antiplatelet agents such as prasugrel and ticagrelor are other alternative strategies that result in more rapid, greater inhibition of platelet function and better outcomes than standard-dose clopidogrel. Whether platelet reactivity-guided therapy or genotyping for cytochrome P450 polymorphisms is useful in managing patients needs to be further defined. Most importantly, early and effective antiplatelet therapy results in the best short- and long-term outcomes for patients with ACS or those undergoing PCI. Catheterization and Cardiovascular Interventions. Volume 79, Issue 2, pages 181–197, 1 February 2012. Article first published online: 26 MAY 2011. DOI: 10.1002/ccd.23163. Copyright © 2011 Wiley-Liss, Inc.
The radial artery is a commonly used conduit for coronary artery bypass grafting. Long-term patency rates are at least as good and in some series are better than for saphenous vein grafts (1,2). However, radial artery graft failure remains a significant problem (3), in particular in cases where radial conduits are used on smaller target vessels or where there is significant competitive flow from a native coronary with a relatively low grade stenosis (4). The string sign, where the radial graft conduit is patent but with only a thread of antegrade flow, is a well-recognized angiographic presentation of radial graft failure (3). We describe for the first time optical coherence tomography (OCT) images of a radial conduit presenting with the string sign. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 5, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2010.10.017.
Revista completa publicada libre por sus editores.
© 2011 Copyright of the published articles is with the correspond- ing journal or otherwise with the author. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the permission of the author or the corresponding journal. ISBN 978-960-93-2840-1. Produced in Thessaloniki, Greece by Ziti Publications. Financial support by the Netherlands Heart Foundation for the publication of this thesis is gratefully acknowledged.
Objectives: The aim of this study was to examine the frequency and causes of surgical explantation of patent foramen ovale (PFO) closure devices. Background: PFO has been linked with cryptogenic strokes, recurrent transient neurologic deficits, sleep apnea, decompression illness, and migraines. Several randomized trials are in progress to determine whether PFO closure is preferable to medical management in the treatment of patients with cryptogenic strokes or migraine. The majority of PFO closures are performed off-label, because there is no U.S. Food and Drug Administration approval for use of any device to close a PFO. As data are accumulating on the benefits of implanting PFO closure devices, it is also important to examine complications that might occur. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 5, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2011.01.009.
Coarctat i on of t he aor ta i ncl udes a wi de ar ray of anatomi cal and pathophysiological variations that may cause important long-term morbidity and mortality. Percutaneous techniques, such as balloon dilation and stenting, allow clinicians to safely decrease or aboli sh most gradients along the aorta, albeit wi th l i mi tati ons. Proper pati ent sel ecti on and i nter venti onal techni que al l ow clinicians to obtain an adequate stretch or therapeutic tear of the vessel wall, but should avoid complications, such as an excessive tear, di ssection, aneurysm formati on or rupture. The i nter venti onal techni que i s tai l ored by pati ent characteri stics such as age, size and growth potential, by characteri stics of the lesion such as degree of narrowing, length, angulation(s) and by local regulations. Future Cardiol. (2012) 8(2), 251–269. ISSN 1479-6678. 10.2217/FCA.12.10. Copyright © 2012 Marc Gewillig.
Intravascular ultrasound (IVUS) has been an important modality in understanding the in vivo pathophysiology of coronary artery disease and in predicting outcome of percutaneous coronary intervention (PCI). The IVUS features associated with acute coronary syndromes include positive remodeling, large plaque burden, ruptured plaque, and intracoronary thrombus. Plaque burden, lesion site calcium, and positive remodeling have been reported to be associated with no-reflow phenomenon and periprocedural myocardial necrosis after PCI (1,2). Attempts to characterize coronary plaques using IVUS were less successful. Although some studies showed that lipid pool-like hypoechoic plaques on IVUS may be associated with periprocedural myocardial infarction, conflicting studies have been reported. It was generally accepted that IVUS is not an ideal tool to detect lipid-rich plaque. However, recent studies reported that echo-attenuated plaque on gray scale IVUS was associated with no-reflow and/or elevated creatine kinase-myocardial band (CK-MB) after PCI, which indicates that this type of plaque contains vasoactive substances, thrombogenic substrates, or rigid material including cholesterol crystal that does not go through the capillary system, causing distal embolization with resultant myocardial necrosis. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 5, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2011.02.004.
A 49-year-old gentleman with history of hyperlipidemia presented to the emergency room with two hours of chest pain. His EKG demonstrated anterior wall ST-elevation myocardial infarction (STEMI). He was given aspirin 325 mg, prasugrel 60 mg and was taken emergently to the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI). Upon diagnostic angiography, the patient was found to have a total occlusion of the left anterior descending coronary artery (LAD) (Figure 1). The remainder of coronary arteries, the left main, circumflex and right coronary arteries, were without significant stenosis. The patient was given 60 units/kg unfractionated heparin. Published on CathLab Digest (http://www.cathlabdigest.com) Issue Number: Volume 20 - Issue 5 - May 2012
Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis. Journal of Cardiovascular Magnetic Resonance 2012, 14:21. Copyright © 2012 Kahlert et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aortic stenosis is a common disorder. Aortic valve replacement is indicated in symptomatic patients with severe aortic stenosis, as the prognosis of untreated patients is poor. Nevertheless, many patients pose a prohibitively high surgical risk and are not candidates for surgical valve replacement. Transcatheter aortic valve implantation (TAVI) is a novel method to treat selected high-risk patients with aortic stenosis. Patient screening and anatomic measurements of the aortic root are of great importance to ensure procedural success and appropriate patient selection. Multidetector computed tomography (CT) is playing an increasingly important role in patient screening protocols before TAVI, provides detailed anatomic assessment of the aortic root and valve annulus, assesses the suitability of iliofemoral access, and determines appropriate coaxial angles to optimize the valve implantation procedure. Additionally, CT is providing a greater understanding of mediumterm valve durability and integrity. This review outlines an evolving role for CT angiography in support of a TAVI program and describe step by step howCT can be used to enhance the procedure and provide a practical guide for the utilization of CT angiography in support of a transcatheter aortic valve program. JACC: CARDIOVASCULAR IMAGING VOL. 4, NO. 4, 2011 Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X. PUBLISHED BY ELSEVIER INC.
Summary: The penetration rate of devices in general, and in transcatheter aortic valve replacement (TAVR) specifically, is significantly delayed in the United States of America (USA) compared with in Europe. This is mostly due to the mission statement of the regulatory agencies in the USA, which requires very rigorous clinical testing of a device prior to its approval. The USA had a major role in the development and evaluation of this technology and USA research has enabled clinicians inside and outside of the USA to conduct a concise scientifically based assessment of the performance of TAVR devices in terms of safety and efficacy. In the following review, we provide data on the development of TAVR in the USA, revealing the critical role the USA has played in this extraordinary process. Archives of Cardiovascular Disease (2012) 105, 160—164. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Summary It is two decades since the first report of transcatheter implantation of a stented aortic valve in an animal. The first implantation of a transcatheter aortic valve in a human was accomplished just one decade ago dramatically demonstrating the promise of this new therapy. Over the past 10 years, there have been rapid developments in valves, delivery systems and technical approaches. Today, transcatheter valve implantation is a technical possibility for the great majority of patients with aortic stenosis. The next 10 years may well see this become the dominant therapy for aortic stenosis. Archives of Cardiovascular Disease (2012) 105, 153—159. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
A 46-year-old woman without a history of cardiovascular disease and no coronary risk factor was urgently admitted to our hospital with rest crushing chest pain, which had started 3 hours before. The ECG demonstrated minimal anterior ST-segment elevation in leads V1 to V4 (Figure 1). In the first sample cardiac troponin T was 0.08 ng/mL. Coronary angiography was urgently performed and demonstrated a 50% smooth stenosis in the proximal left anterior descending (LAD) coronary (Figure 2) with a faint dye staining just proximal to the first diagonal branch. Because initial differential diagnosis included variant angina, intracoronary ergonovine (32 μg) was given. Diffuse LAD coronary vasoconstriction, more severe on the LAD coronary ostium, was seen. Because there was still no clear indication of a culprit lesion, intravascular ultrasound (IVUS) examination was performed, which surprisingly showed an intramural hematoma starting from the mid-LAD up to its ostium, with mild lumen compromise, and the presence of nonobstructive atheroma. Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 1941-7640. Online ISSN: 1941-7632
Objectives: This study examined morphological characteristics of echo-attenuated plaques by optical coherence tomography (OCT) and evaluated their influence on creatine kinase-myocardial band (CK-MB) elevation after percutaneous coronary intervention (PCI) in patients with elective stent implantation. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 5, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2010.12.013.
Objectives: The aim of this study was to analyze volumetric plaque composition of the coronary arterial tree according to the classical cardiovascular risk factors and metabolic syndrome (MS) using virtual histology–intravascular ultrasound (VH-IVUS). Background: It remains unclear how the cardiovascular risk factors correlate with the histological components of coronary plaques. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 4, NO. 5, 2011. Copyright © 2011 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00. PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2010.12.015.
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