[Extra-cranial carotid artery disease in patients with chest pain]

The usual course of coronary artery disease [CAD] can be complicated when it is accompained with cerebral accidents. Objective of this article is to evaluate the frequency of cerebral vascular involvement in these patients, and to study the correlation between the severity and extent of the disease in coronary and carotid arteries. After performing a coronary angiography in 107 patients complaining of chest pain [63 Male/44 Female, average age of 56.62 and SD=12.23 years], carotid arteries were studied by gray scale, color and spectral Doppler ultrasound scanning for intima-media thickness, atherosclerotic plaque and lumen stenosis in their cervical course. There was single coronary artery stensosis [SVD] in 21 cases [19.6%], two-vessel stenosis [2VD] in 14 [13.1%] and left main stem [LMS] or three-vessel involvement [3VD] in 37 cases [34.6%]. There was concomitant carotid involvement in 54 of these patients, 46 of them [43%] having less than 60% and 8 patients having equal or more than 60% carotid stenosis. 66.7% of patients with CAD showed evidences of carotid artery disease as well, but in patients without CAD there was sonographic evidences of carotid artery disease in only 17.1%. [P=0.000]. Carotid artery disease was detected in 52.4% of patients with SVD and in 78.6% of patients with 2VD and in 70.3% of patients with 3VD. In patients with normal coronary angiography there was only 5.7% carotid involvement. In this study we found a strong correlation between the presence and the extent of CAD and carotid artery disease in our patients. Our study confirms a relatively high frequency of carotid artery disase in patients suffering from CAD and a great correlation between the sever coronary artery disease and significant carotid disease. According to these results, carotid sonography can be recommended as a method of evaluation before reconstruction of coronary artery in patients suffering from widespread coronary involvement

Percutaneous balloon pericardiotomy in a patient with recurrent pericardial tamponade

Malignancy is the leading cause of chronic pericardial effusion. Although maybe not life-threatening as the acute tamponade, by compressing cardiac cavities and adjacent organs, causes significant morbidity and discomfort for the patient. Its early diagnosis and effective and safe treatment would have significant role in improving the patint's quality of life and his life expectancy

There are various treament modalities with different success rate including,pericardiocentesis alone [average success rate of 47%] or with indwelling catheter drainage [78%], sclerotherapy [83%], external radiotherapy [69%], and surgery [success rete of 48-92% for different techniques], and Percutaneous balloon pericardiotomy [96%]

Percutaneous balloon pericardiotomy is a promising nonsurgical therapy, especially in malignant recurrent tamponade, in which after drainage of pericardial fluid through subxiphoid pericardiotomy, using a balloon catheter, a window is created in parietal pericardium

Generally it has the same early and late results as surgical Pericardiotomy, especially in malignancies, with less morbidity. But its role in the management of nonmalignant pericardial effusion is not clear. Here, in addition to introducing this method, we report successful treatment of a case of recurrent temponade with past history of treated gastric cancer