Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.

Delayed Stent Fracture after Successful Sirolimus-Eluting Stent(Cypher(R)) Implantation

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stent (SES) is very effective for preventing in-stent restenosis through the suppression of neointimal proliferation. Treatment failure cases related to stent fracture have recently been reported on, but any studies concerning the pattern or mechanism of SES fracture are very rare. SUBJECTS AND METHODS: Between December 2003 to January 2005, 457 patients underwent follow-up coronary angiography after SES implantation at three referral center. We reviewed the angiographic and procedural data for eleven of theses patients [6 males (55%), mean age: 60 year-old age, range: 43-74 years] who were proven to have experience complete SES fracture. RESULTS: The left anterior descending artery (LAD) and right coronary artery (RCA) stent fracture were 7 cases (63%) and 4 cases (37%), respectively. Myocardial bridge was shown in 6 cases with LAD fracture (86%). Overlapping stent implantation was performed in 5 cases (45%). The mean value of the maximal angulations at the fracture site before intervention was 50 degrees (range; 39-70 degrees) and the mean change between the maximal and minimal angulations was 13.2 degrees (range; 2-28 degrees). The mean stent diameter and length were 3.0 mm (range; 2.75-3.50 mm) and 40 mm (range; 23-52 mm). Stent inflation with high pressure was performed on 6 cases (54%) and it's frequency was higher in the RCA than the LAD (3 cases, 75%, mean inflation pressure: 13.1 mmHg). The mean follow-up duration was 7.2 month and only 2 cases were admitted due to the recurrent chest pain. The binary restenosis rate was 55% (6 cases) and the restenotic lesions were treated by balloon angioplasty in 2 cases and additional stenting was done in 2 cases. CONCLUSION: Our results demonstrated that SES fracture occurred in 7 cases with LAD lesion and in 4 cases with RCA lesion. Long stenting including overlapping implantation and more than 40 degrees angulated long stent implantation may be the factors for SES fracture. Our results also showed high pressure stent inflation was performed more frequently at the RCA lesion, and myocardial bridge and kinking motion was detected more frequently at the LAD lesions.

Efficacy and Safety of Amlodipine Camsylate(Amodipin(TM)) for Treatment of Essential Hypertension

BACKGROUND AND OBJECTIVES: Amlodipine camsylate (Amodipin(TM)), a newly developed amlodipine formulation, has similar physical properties and pharmacokinetic equivalency to that of the conventional formulation (amlodipine besylate, Norvasc(R)). SUBJECTS AND METHODS: This prospective, randomized, double-blind, parallel designed, multicenter study was conducted at a total of 7 sites. 95 patients with mild to moderate essential hypertension were enrolled. Following the 2 week administration of a placebo, the patients received 5 mg of amlodipine once a day for a total of 8 weeks. If either the blood pressure was > or =140/90 mmHg or the sitting diastolic blood pressure had not decreased by > or =10 mmHg from those at the baseline after 4 weeks of treatment, the dose of amlodipine was increased to 10 mg. The blood pressure was measured twice every 4 weeks and mean value recorded. RESULTS: The diastolic and systolic blood pressures were significantly decreased with both amlodipine camsylate (baseline DBP: 97.4+/-5.8 mmHg, 8th week DBP: 84.1+/-8.8 mmHg, mean differences: -13.3+/-7.4) and amlodipine besylate (baseline DBP: 95.9+/-5.9 mmHg, 8th week DBP: 83.2+/-9.2 mmHg, mean differences: -12.4+/-8.3). The incidence of drug related adverse events was similar in both groups. CONCLUSION: This study suggests that once-a-day monotherapy of amlodipine camsylate is effective for the control of blood pressure in patients with essential hypertension, without significant adverse events.

The Effects of a Carbon Ion Implantation Technique on In-stent Restenosis: Korean Multicentered Randomized Trial

BACKGROUND AND OBJECTIVES: Heavy metal ions released from a stainless steel stent can induce an inflammatory reaction that might be associated with in-stent restenosis. A carbon ion implantation technique, which physically integrates carbon ions into the surface of the stainless steel lattice, can block heavy metal ion diffusion, and improve the biocompatibility. This study was designed to evaluate the efficacy of a carbon ion implanted Arthosinert stent on the reduction of in-stent restenosis and the improvement in the clinical outcomes. SUBJECTS AND METHODS: 193 de novo coronary lesions in 191 anginal patients at 14 centers, with reference diameters from 2.75 to 4.5 mm, were randomly assigned to either an Arthosinert (100 patients, 102 lesions) or an Arthos (91 patients, 91 lesions) stent. The lesion length was 14.1+/-5.7 mm. The ACC/AHA (American College of Cardiology/American Heart Association) lesion classifications were A:15.0%, B1:36.8%, B2:35.8% and C:12.4%. The study end points are angiographic restenosis, during a six-month follow-up, and Major adverse cardiac event. In-stent restenosis was defined as a diameter of stenosis > or =50%. RESULTS: A six-month angiographic follow-up was obtained for 72.3% (138/191) of the subjects. There were no significant differences between the Arthosinert and Arthos groups in the rates of restenosis (17.8% vs. 31.8%, p=0.055) and Target vessel revascularization (7.0% vs. 11.0%, p=0.476). There were no deaths or non-fatal myocardial infarction in either group. CONCLUSION: The treatment of de novo coronary stenosis, with carbon ion implanted stents, showed a tendency for lower six-month angiographic restenosis rates than the conventional 316L stainless steel stents. A larger trial will be needed to confirm the efficacy of the carbon ion implanted stent.

A Case of Gigantic Ectasia of Right Coronary Artery Associated with Acute Myocardial Infarction

Coronary artery ectasia is an uncommon disorder diagnosed in 1 to 4% of patients undergoing coronary arteriography. Coronary artery ectasia is often considered a variant of atherosclerotic coronary artery disease, although other causes should be considered. Complications from this disease usually occur as thrombo-embolic phenomena primarily due to thrombosis in the ectatic segment of the coronary artery. A 53-year old man was transferred to our ER, presenting with acute inferior wall infarction. Coronary angiogram showed a gigantic ectatic right coronary artery (RCA) with occlusion of the mid portion by a huge mural thrombus. We injected and infused glycoprotein IIb-IIIa inhibitor in the RCA, however the lysis of thrombus was minimal. Subsequently, we infused Urokinase into the RCA for 2 days. Follow-up angiography revealed partial lysis of the thrombus. The patient demonstrated no thrombo-embolic events during two months of coumadinization, and follow-up angiography revealed a complete lysis of the thrombus.

Clinical Observation on Effect of Amlodipine in Angina Pectoris

We evaluated the clinical effects of amlodipine in 10 patients(7 male and 3 female) with angina pectoris in terms of the effect on the anginal pain, hemodynamic changes and side effects. The results obtained were as follows; 1) The clinical improvement was obsebed in 8(80.8%) of 10 and 9(88.9%) of 9 patients at 2 and 10 weeks after oral amlodipine. 2) The systolic and diastolic blood pressure was decreased significantly(136.0+/-16.5mmHg vs 117.0+/-10.6mmHg, p<0.01 and 85.0+/-9.7mmHg vs 75.0+/-5.3mmHg, p<0.01 respectively) but the heart rate was indepentent of amlodipine administration. 3) The adverse effects of amlodipine were as headache in 3, facial flushing in 3, palpitation, dizziness, urinary difficulty in 1 respectively and one of them discontinued amlodipine due to severe palpitation and facial flushing.

Coronary Arteriographic Findings in Myocardial Infarction

No abstract available.