Background: The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography, we investigated potential causes of this adverse event.
A 66-year-old man was admitted to our emergency department for treatment of acute thromboses of multiple abdominal vessels (abdominal aorta, splenic artery and vein, inferior mesenteric artery, and portal vein). Chest computed tomography (CT) performed 2 days before admission showed no abnormality in the left ventricular myocardium.
Background: The fractional flow reserve (FFR) value of 0.75 has been validated against ischemic testing, whereas the FFR value of 0.80 has been widely accepted to guide clinical decision making. However, revascularization when FFR is 0.76 to 0.80, within the so-called gray zone, is still debatable.
Background: Patients with atrial fibrillation (AF) often take multiple medications.
Case presentation: A 62-year-old woman presented to the emergency department with the acute onset of paresthesia and severe left arm pain; an aortogram revealed an occlusion of the proximal left subclavian artery (Figure 1). The patient underwent emergency right-to-left axillary-axillary bypass grafting and was discharged on aspirin 81 mg. She again presented to the hospital 4 weeks later with symptoms of a stroke; magnetic resonance imaging and angiography revealed multiple left-sided acute embolic infarcts and proximal occlusion of the left internal carotid and vertebral artery (Figure 2). The patient underwent emergency endarterectomy during which fresh thrombus was removed; of note, there was no underlying atherosclerotic plaque. Three days after surgery, the patient developed a deep venous thrombosis and subsequent bilateral pulmonary emboli of the left leg. A transesophageal echocardiogram revealed the presence of a patent foramen ovale (PFO), an atrial septal aneurysm, and a large right-to-left shunt (Movie I in the online-only Data Supplement). A hypercoagulable workup was positive for heterozygous factor V Leiden mutation.
Background: Quadricuspid aortic valve (QAV) is a rare congenital cardiac defect. This study sought to determine QAV frequency in a large echocardiography database, to characterize associated cardiovascular abnormalities, and to describe long-term outcomes.
Background: Cangrelor is an intravenous ADP receptor antagonist that leads to potent and reversible inhibition of platelet aggregation. The relative safety and efficacy of some antiplatelet drugs in women has been disputed.
Transcatheter aortic valve replacement has become an established treatment for patients with symptomatic aortic valve disease deemed inoperable or at high risk for conventional surgical aortic valve replacement. Although it is a less invasive catheter-based procedure, it is associated with some potentially fatal complications. Acute rupture of the descending aorta is unusual and almost invariably has a lethal outcome. This complication should be suspected in the case of unexplained hypotension during catheter advancement. In our case, we hypothesize that the aortic rupture at the time the delivery system was advanced was attributable to the presence of an acute angle in the aortic arch that transmitted resistance to the delivery system and kinked the descending aorta in the proximal angle. This case gives further evidence that careful evaluation, selection of the patient candidates, and the approach for transcatheter aortic valve replacement are crucial, and must be discussed on a case-by-case basis, considering the benefit–risk ratio.
Background: Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients.
Background: We previously described a strong association between fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection. Angiographic manifestations of coronary FMD aside from dissection were considered rare. However, we observed several coronary FMD angiographic abnormalities with corresponding optical coherence tomography abnormalities.
Background: Off-label use of transcatheter aortic and pulmonary valve prostheses for tricuspid valve-in-valve implantation (TVIV) within dysfunctional surgical tricuspid valve (TV) bioprostheses has been described in small reports.
Background: The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.
A 54-year-old woman was admitted with systolic murmur and exertional dyspnea. ECG demonstrated right ventricular hypertrophy with an rsR’ pattern in the leads on the right side of the chest. Chest x-ray revealed cardiomegaly, increased pulmonary arterial vascularity, and prominent main pulmonary artery segment. The cardiothoracic ratio was 57%.
Background: Transcatheter closure of secundum atrial septal defects (ASD) using the Amplatzer septal occluder is generally safe and effective, but erosion into the pericardial space or aorta has been described. Although the absolute risk of this complication is low, there has been no assessment of relative risk factors.
Background: Patients with diabetes mellitus (DM) are at high risk for recurrent ischemic events after coronary stenting. We assessed the effects of continued thienopyridine among patients with DM participating in the Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis.
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