1/17. Primary and elective stenting of unprotected isolated left main coronary ostial stenosis in acute coronary syndrome.Direct surgical angioplasty or coronary artery bypass graft has been done in patients who have left main coronary ostial stenosis. Recent reports have demonstrated that stenting of unprotected left main coronary artery stenosis has been attempted as an alternative to bypass surgery in selected patients with normal LV function. We report two patients with isolated left main coronary ostial stenosis who are undergoing primary and elective stenting, respectively. Major cardiac events did not occur during a 3-month follow-up. This study suggests that stenting of isolated left main coronary ostial stenosis in acute coronary syndrome is feasible and results in excellent outcomes.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
2/17. Stenting of an anomalous left circumflex coronary artery arising from the right coronary artery.Coronary angioplasty can provide excellent means of revascularization of anomalous coronary arteries. Successful application of angioplasty to these vessels requires angiographic knowledge of their course, structure and appropriate equipment selection. Advancement of stent delivery systems in such cases requires good support with the possibility of selective cannulation and deep engagement of the guiding catheter. We report a case of stent placement in an anomalous circumflex artery arising from the right coronary artery.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
3/17. Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension.Angina is a common symptom of severe pulmonary hypertension. Although many theories for the source of this pain have been proposed, right ventricular ischemia is the one most commonly accepted as the cause. We report on two patients with primary pulmonary hypertension who had angina with normal activity or on provocation. One patient had severe left ventricular dysfunction. Both were found to have severe ostial stenosis of the left main coronary artery as a result of compression from a dilated pulmonary artery. Both patients underwent stenting of the left main coronary artery with excellent angiographic results, and complete resolution of the signs and symptoms of angina and left ventricular ischemia. Left ventricular ischemia due to compression of the left main coronary artery may be a much more common mechanism of angina and left ventricular dysfunction in patients with pulmonary hypertension than previously acknowledged. Stenting of the coronary artery can be done safely with the resolution of these symptoms.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
4/17. Stenting unprotected left main coronary artery stenosis in heart transplant patients--the good, bad, and the ugly.The major cause of late death following orthotopic heart transplantation is coronary artery vasculopathy. Approximately 50% of heart transplant patients have coronary artery vasculopathy 5 years post-transplantation. With advances in interventional cardiology technology, heart transplant patients with selected lesions are now undergoing intravascular stenting with acute-gain and late-loss rates similar to stenting in non-transplanted patients. We describe 3 consecutive cases of stenting unprotected left main coronary artery disease in orthotropic heart transplant patients. With follow-up to 3 years and no evidence of restenosis, these results suggest that stenting unprotected left main coronary artery lesions in heart transplant patients can be performed with excellent immediate and long-term results.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
5/17. Successful catheter interventional therapy for acute coronary syndrome secondary to kawasaki disease in young adults.acute coronary syndrome occurred in 2 young adults who had a history of Kawasaki disease (KD), but few other coronary risk factors. The first patient was a 27-year-old male with acute myocardial infarction without stenosis detected by coronary arteriography 4 years earlier. Emergency coronary arteriography showed occlusion of the right coronary artery. Aspiration-thrombectomy and rescue balloon angioplasty were successfully performed. The second patient was a 32-year-old male with unstable angina. Right coronary arteriography showed total occlusion with severe calcification. Left coronary arteriography showed 99% stenosis at the proximal site of the circumflex artery, and a directional coronary atherectomy was performed. Histological examination of a specimen from this site revealed a lipid core, macrophages, and smooth muscle cells. Restenosis was not observed on follow-up coronary arteriography after 5-6 months in either case. The coronary stenosis in each case was probably caused by accelerated atherosclerosis at the site without aneurysm as it seemed to be 'normal' on arteriography. Conventional catheter intervention was effective treatment. The sequelae of KD should be recognized as independent coronary risk factors.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
6/17. Percutaneous treatment of early occlusion of a complex arterial coronary graft: a case report.The internal mammary arteries are now widely used for surgical myocardial revascularization. Because of its excellent long-term patency rates, re-do surgery is rarely requested and transluminal percutaneous angioplasty of these arterial grafts is still relatively infrequent. This procedure is performed mainly at the distal anastomotic site but also at the origin of the vessel from the subclavian artery, frequently just to treat a local traumatic dissection due to the catheter. We here report the case of a successful angioplasty and stenting of the body of the graft for an early total occlusion of a complex, bifurcated arterial bypass to the left coronary system.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
7/17. radiation-induced ostial stenosis of the coronary artery as a cause of acute coronary syndromes: a novel mechanism of thrombus formation?Mediastinal irradiation can induce coronary artery disease characterized by fibrous lesions developing in the absence of lipid/foam cell accumulation. We document several consecutive cases of acute coronary artery occlusion developing over radiation-induced lesions in patients who were relatively young, without evidence of classical risk factors for atherosclerosis, and in whom the coronary vasculature was otherwise apparently free of disease. The finding of acute coronary artery occlusion at the site of a fibrous lesion lends further support to the hypothesis that acute coronary syndromes may not necessarily be identifiable with ulceration/disruption of the atherosclerotic plaque as the underlying mechanism of acute thrombus formation.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
8/17. Cellular cardiomyoplasty for a patient with heart failure.BACKGROUND: A 73-year-old man with a history of myocardial infarction and hypertension for 5 years suffered heart failure (NYHA III-IV). methods: 2D echo indicated hypokinesia at septal, left ventricular anterior wall and apical regions. Coronary angiograms demonstrated 60% stenosis in distal left main and 99% stenosis in proximal and distal left anterior descending coronary arteries (LAD). Both proximal artery and middle left circumflex coronary artery (LC) had 90% stenosis, and diffuse stenosis of right coronary artery (RC) was found. myocardial perfusion imaging using 99mTc-MIBI indicated defective perfusion of left ventricular apex, anterior wall and septal region and severe reduced perfusion of posterior inferior wall. Myocardial metabolic activities (18F-deoxyglucose) also showed comparable reductions. After exposing the heart, LAD, LC, and RC were all completely occluded and bypass procedure could not be completed. Autologous satellite cells were implanted without any complication and the patient had an uneventful recovery. RESULTS: During the first 2 months, he remained in heart failure, and by the third month, he gradually improved and reached NYHA II. At fifth month after the procedure, significant increased ejection fraction (37.1-48.6%) and wall movement with modest reduction of left ventricular systolic diameter (48-45 mm) were observed. Imaging with 18F-deoxyglucose showed dramatic improvement in myocardial metabolic activity with similar improvement in myocardial perfusion (99mTc-MIBI). CONCLUSION: This is the first successful case of cellular cardiomyoplasty without any conjunctional procedure for patient with severe coronary heart disease and heart failure.- - - - - - - - - - ranking = 2keywords = cell (Clic here for more details about this article) |
9/17. Autologous patch angioplasty of the left main coronary artery in a pediatric patient: 7-year follow-up.We present a patient who developed ischemia after an arterial switch procedure for transposition of the great vessels secondary to left coronary artery stenosis. The excellent intermediate-term result of patch angioplasty of the left main coronary artery with the use of an internal thoracic artery patch is outlined.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
10/17. Unique angiopathy after herpes virus infection.OBJECTIVE: We describe 3 Japanese patients with peculiar renal and/or coronary arterial stenosis and/or multiple aneurysms after herpes virus infection, following ischemic symptoms. We investigated for viral antigens and viral dna in situ, and for shared abnormalities of cellular immunity. methods: Panarteriography was performed diagnostically, and patients were grouped as follows: 3 patients with peculiar renal and/or coronary artery narrowing and/or multiple aneurysms; another 3 patients with renal fibromuscular dysplasia; and other young adults with effort angina, with no history of herpes virus infection, as controls. Detection of viral antigens and viral dna in situ was done by polymerase chain reaction method and immunohistochemical staining. Cellular immunity was examined at the time of ischemic symptoms. RESULTS: Viral antigens and dna were scarcely detected, except in herpes zoster skin lesion with leukocytoclastic vasculitis. However, shared abnormalities of cellular immunity, such as a decreased CD4 T cell number and reduced natural killer cell activity, were more prominent in the 3 patients with unique vasculopathy after herpes virus infection. CONCLUSION: Unique vasculopathy following herpes virus infection might be a more severe and extensive disease. We speculate that sustained viral infection, repetitive activation of virus related antigens, and suppressed immune state might contribute to formation of peculiar vascular alterations.- - - - - - - - - - ranking = 4keywords = cell (Clic here for more details about this article) |
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