A 76-year-old woman was transferred to our institute due to recurrent severe aortic stenosis (AS). Seventeen months ago, severe AS was treated with a transfemoral 25-mm nonmetallic Direct Flow valve (Direct Flow Medical, Santa Rosa, California) (Figures 1A and 1B). After this procedure, the mean aortic valve pressure gradient (PG) decreased from 31 to 13 mm Hg. However, her symptoms gradually worsened. Transesophageal echocardiography demonstrated the recurrence of AS and a calcified conglomerate without any leaflet motion (Figure 1C). Although she had no medical conditions related to the severe calcification such as renal dysfunction or history of radiation therapy, computed tomography images before Direct Flow valve implantation revealed a dominant bulky calcification close to the right coronary cusp adherent to the coronary supra-annular wall.
A 59-year-old man with hypertension and hyperlipidemia presented with symptoms of chest pain, claudication, and erectile dysfunction. He reported exertional chest discomfort occurring with less than a flight of stairs and bilateral lower extremity pain after walking 40 feet. Claudication persisted despite treatment with cilostazol. Ankle-brachial indices and distal pulses were reduced in both legs (right and left ankle-brachial indices = 0.7 and 0.8, respectively).
Bioresorbable vascular scaffolds (BVSs) have many hypothetical advantages over metal stents due to early restoration of vasomotion, unimpaired imaging with computed tomography, as well as the maintenance of potential insertion sites for future bypass grafting.
Hypertrophic obstructive cardiomyopathy and concomitant systemic hypertension can present a challenging diagnostic and therapeutic dilemma. Symptoms can occur from increased afterload from both dynamic outflow obstruction as well as the elevated systemic vascular resistance. Treatment of systemic hypertension with reduction in preload (diuretics) or afterload (vasodilators) may improve symptoms if the overall afterload on the left ventricle is reduced and also improve long-term outcome. However, treatment for hypertension may also exacerbate dynamic left ventricular outflow tract (LVOT) obstruction (1). Invasive hemodynamic assessment with nitroprusside challenge can be helpful in determining the response to medical management.
A 33-year-old man presented with chest pain and dynamic ST-segment elevation in the anterior leads. Coronary angiography revealed dissection in the mid-segment of the left anterior descending coronary artery (LAD) with luminal compression and Thrombolysis In Myocardial Infarction flow grade 2 (Figure 1, Online Video 1). This was confirmed on the subsequently performed optical coherence tomography (OCT) (Figure 2). Given his young age, we deployed 2 overlapping bioresorbable vascular scaffolds (BVS) (3.0 × 18 mm and 3.5 × 28 mm), achieving good angiographic and OCT results (Figure 3, Online Video 2).
Background: We aimed to compare the long-term clinical outcomes between fractional flow reserve (FFR)–guided and routine drug-eluting stent (DES) implantation in patients with an intermediate coronary stenosis.
Introduction: Atrial fibrillation (AF) is a growing problem, affecting 5.2 million people in the United States in 2010, with a prevalence that is expected to increase to over 12 million by 2030.1,2 The standard of care for stroke prevention in such patients at increased risk, as indicated by a congestive heart failure, hypertension, age ≥75 y (doubled), diabetes mellitus, prior stroke or TIA or thromboembolism (doubled), vascular disease, age 65–74 y, sex category (CHA2DS2-VASc) score3 ≥1, is anticoagulation with a vitamin K antagonist (VKA) or novel oral anticoagulant (NOAC).
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes (ACS), typically affecting female and younger individuals with no underlying atherosclerotic disease.1 Diagnosis of SCAD has traditionally relied on coronary angiography; however, new imaging modalities, and especially optical coherence tomography (OCT), improve diagnostic accuracy and help management.2 The optimal treatment strategy remains controversial and may vary from a completely conservative approach to percutaneous or even surgical revascularization, always guided by the clinical scenario and symptoms.
Background: There are currently inadequate data about whether late restenosis occurs after drug-eluting stent (DES) implantation in patients with DES restenosis.
Background: Current guidelines suggest that coronary artery bypass grafting (CABG) should be the preferred revascularization method for unprotected left main coronary artery stenosis. In light of evidence from recent randomized trials, we assessed whether percutaneous coronary intervention (PCI) using drug-eluting stents is as safe and effective as CABG for the treatment of unprotected left main coronary artery disease.
Aims: Genetics plays an important role in coronary heart disease (CHD) but the clinical utility of genomic risk scores (GRSs) relative to clinical risk scores, such as the Framingham Risk Score (FRS), is unclear. Our aim was to construct and externally validate a CHD GRS, in terms of lifetime CHD risk and relative to traditional clinical risk scores.
Aims: High-sensitivity cardiac troponin (hs-cTn) assays provide higher diagnostic accuracy for acute myocardial infarction (AMI) when compared with conventional assays, but may result in increased use of unnecessary coronary angiographies due to their increased detection of cardiomyocyte injury in conditions other than AMI.
Aims: Ticagrelor reduces ischaemic events and mortality in acute coronary syndrome (ACS) vs. clopidogrel. We wished to study clinical outcomes in a large real-world population post-ACS.
Aims: Compared with bare metal stents, first-generation drug-eluting stents (DES) are associated with an increased risk of late restenosis and stent thrombosis (ST). Whether this risk continues or attenuates during long-term follow-up remains unknown.
Aims: In percutaneous coronary intervention for de-novo coronary bifurcation lesions, the optimal technique for provisional side-branch stenting is still a matter of debate. We tested whether in this setting culotte stenting reduces the incidence of restenosis as compared with T-and-protrusion (TAP) stenting.
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