1/20. 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.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/20. 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.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/20. Successful long-term therapy following saphenous vein-covered stent deployment for atherosclerotic coronary aneurysm.We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/20. coronary artery bypass grafting for a patient with tangier disease.A 56-year-old man with tangier disease suffering from angina pectoris due to triple-vessel coronary artery disease evidenced extremely low blood high-density lipoprotein of 1 mg/dl, a specific laboratory indicator of this rare genetic disorder of lipid metabolism, considered to accompany juvenile arteriosclerosis. Because of the calcified ascending aorta, we conducted combined minimally invasive coronary artery bypass (CAB) for the left anterior descending coronary artery and percutaneous transluminal coronary angioplasty for other coronary artery lesions initially instead of conventional coronary artery bypass grafting. Angina recurred, however, due to refractory restenosis of the left circumflex coronary artery lesion. Two years later, we redid the CAB, grafting the free right internal thoracic artery from the functional left internal thoracic artery sequentially onto obtuse marginal and posterolateral coronary arteries. The patient returned to work angina-free.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/20. Histopathology of coronary in-stent restenosis following gamma brachytherapy.The histopathology of in-stent restenosis (ISR) following gamma brachytherapy is described. Such histology has not been reported previously. An 82 year old man presented with recurrent ISR three months after gamma brachytherapy to an area of ISR within a native circumflex vessel. The recurrent ISR was treated with directional coronary atherectomy; the histopathology of this directional coronary atherectomy specimen is discussed. These histopathological examinations showed abundant extracellular matrix material. Surprisingly, there was a relatively small cellular (myofibroblastic) component, with an absence of endothelial cells and little evidence of active proliferation. ISR after gamma brachytherapy may be a pathologically distinct entity.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/20. Bivalirudin (Angiomax) use during intracoronary brachytherapy may predispose to acute closure.We describe two cases of intracoronary vascular brachytherapy where bivalirudin (Angiomax), employed as an anticoagulant, led to abrupt vessel closure or threatened abrupt closure. Use of bivalirudin (Angiomax) during intracoronary brachytherapy may predispose to the formation of intracoronary thrombus, related to the reversible binding kinetics of the bivalirudin to thrombin, and resulting in recovery of thrombin functional activity during periods of prolonged stasis that occur during intracoronary brachytherapy. Intracoronary abciximab administration may be a useful strategy in resolving the acute closure, since abciximab administered early during the formation of thrombus has been shown to facilitate clot lysis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/20. Late thrombosis after gamma-brachytherapy.Late stent thrombosis (> 30 days after treatment) is a new phenomenon occurring after vascular brachytherapy. We report the analysis of 11 patients with late thrombosis after gamma-irradiation treatment of in-stent restenosis. All patients had in-stent restenosis and angina. Contributing factors to late thrombosis include long stents, small distal vessels, and complex lesion morphology.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/20. Complex transradial three vessel brachytherapy in a single session.BACKGROUND: We report the case of a patient who underwent transradial brachytherapy in 3 different coronary vessels during a single session. She initially presented with unstable angina 4 months after the index procedure; control angiography showed severe and diffuse in-stent restenosis in the LAD, Cx and Mg arteries. methods: After successful dilatation of the three vessels, we performed vascular brachytherapy using the Novoste Beta-Rail system and a 60 mm length source train of 90Sr/Y radioactive seeds. No further stent was implanted. The patient left the hospital the next day. Follow-up angiography revealed widely patent vessels with no restenosis. CONCLUSION: Transradial multivessel brachytherapy can be done during the same session.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
9/20. Treatment of bifurcation in-stent restenotic lesions with beta radiation using strontium 90 and sequential positioning pullback technique: procedural details and clinical outcomes.BACKGROUND: In-stent restenotic lesions have been problematic for many patients with the need for multiple repeat percutaneous coronary interventions (PCI). The need for repeat PCI has been significantly reduced in patients since the advent of vascular brachytherapy. In-stent restenosis resulting in bifurcation presents even more of a challenge. The use of radiation therapy for the treatment of this kind of lesion has not yet been reported. The purpose of this paper is to present five cases of radiation therapy in bifurcation in-stent restenotic lesions using the intraluminal beta radiation catheter delivery system (Beta-Cath System, Novoste Corporation, Norcross, georgia). methods: We reviewed the database of patients enrolled in our Compassionate Use Registry between August 1999 and April 2002. The data is reported for 5 patients who received radiation in both branches of bifurcation lesions with the Beta-Cath catheter system. RESULTS: The mean diameter of the vessels was 3.1 mm 0.5 mm. The dose administered was from 18.3 to 23 Gy, with an overlap of 3.3 to 10.3 mm; the hinge angle between the branches went from 43.3 to 65.4 . Angiographic follow-up was obtained at 6 months in 4 patients, with a single patient showing a focal (< 5 mm) edge lesion treated by balloon angioplasty (TVR no TLR). No aneurysms or zones of ectasia were noted. CONCLUSION: Beta radiation with the Beta-Cath catheter system appears to be safe, secure and clinically useful in in-stent restenotic bifurcation lesions.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/20. Inadvertent intracoronary stent extraction 10 months after implantation complicating cutting balloon angioplasty for in-stent restenosis.We report the case of an unusual complication for Cutting Balloon angioplasty (CBA) during treatment for instent restenosis (ISR), which resulted in inadvertent intracoronary stent extraction 10 months after implantation. In this case report, CBA was utilized to treat an ISR lesion in the distal right coronary artery (RCA). Due to difficulty in withdrawing the cutting balloon into the guide after treatment of the lesion, the entire system (guide, cutting balloon, and guidewire) was removed as a unit from the body. Upon examination of the system, the previously placed stent in the distal RCA was attached to the microtomes of the cutting balloon. Although the precise mechanisms for stent extraction in this case remain speculative, the initial stent used in the distal RCA may have been undersized, and this may have played a major role in this complication. Although there is limited data regarding the optimal strategy to treat the site of the inadvertent stent extraction, we opted to re-stent the area with a properly-sized coronary stent. Following the intervention, there was no residual stenosis with TIMI 3 flow through the vessel. The patient remained asymptomatic and a serum troponin drawn 18 hours after the procedure was normal, and he was discharged the next day. The interventionist must be vigilant about this rare but serious complication when applying CBA in the treatment of ISR, particularly when an undersized or underdeployed stent is suspected.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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