Short-Term Follow-up Results of Periacetabular Osteotomy for Hip Dysplasia

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy for the treatment of hip dysplasia. MATERIALS AND METHODS: We performed a clinical and radiological assessment of 20 periacetabular osteotomies (19 patients), which had been followed up for > 1 year. The mean age of the patients at the time of surgery was 34.2 years (range, 18~50 years). The average follow-up period was 26.7 months (range, 12~85 months). The Harris hip score and range of motion were used for clinical evaluation. The radiologic measurements were evaluated using the acetabular angle, center-edge angle, acetabular depth, femoral head coverage, and medialization. RESULTS: The mean Harris hip score improved from 59.6 points to 96.4 points. The mean acetabular angle improved from 47.9 degrees to 26.4degrees. The mean center-edge angle increased from 14.2degreesto 41degrees. The acetabular depth increased from 176 to 242.7 The mean femoral head coverage increased from 63.3% to 95.4%. The following complications were noted: hematoma in 2 cases, temporary lateral femoral cutaneous nerve palsy in 3 cases, and superficial wound infection in 1 case. CONCLUSION: Periacetabular osteotomy is an effective surgical treatment for hip dysplasia.

Results of Femoro-Below Knee PTFE Bypass Graft

PURPOSE: Saphenous vein allografts are used for femoral-below knee bypass graft purposes in chronic lower limb ischemia. Polytetrafluoroethylene (PTFE) is an acceptable material for bypass graft, when it is difficult to gain a suitable vein for the graft material, such as the great saphenous, small saphenous, or arm vein. However, some controversy exists as to whether PTFE is equivalent to the saphenous vein as bypass graft material for femoral below knee revascularization. A retrospective analysis was performed to obtain results about femoral-below knee bypass graft using PTFE in chronic lower ischemia patients. METHOD: Between July 1992 and June 2002, 56 patients with chronic lower limb ischemia underwent femoral-below knee bypass graft. The results of treatment were analyzed retrospectively by the patients's clinical records. Kaplan-Meier analysis was used to estimate patency rate. RESULT: There were 52 men and 2 women, of mean age 66.6 years. The primary patency rate was 65.6%, 44.9%, 38.0%, and 34.0%, and the secondary patency rate was 85.7%, 72.0%, 72.0%, and 56.1%, after 1, 2, 3, and 5 years, respectively. The limb salvage rate was 78.8% in severe lower limb disease, such as disabling claudication, non-healing ulcer, and gangrene. The major amputation rate was 14.3%. There was no mortality within one month after bypass operation. The primary and secondary rates were not correlated with diabetes, inflow procedure, or severity of lower limb ischemia. CONCLUSION: The overall results of this study show that PTFE grafts have an acceptable patency rate when used for femoral-below knee bypass surgery in patients with chronic lower limb ischemia. This study suggests that early diagnosis of occlusion in graft and adjuvant procedures offers improved patency and limb salvage rate.

The Long-Term Clinical Outcomes of Primary PTCA with Heparin-Coated Stent in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been reported to be effective reperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment of AMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stented vessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. The aim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents in AMI. SUBJECTS AND METHODS: Between January 1998 and July 2002, primary PCI with heparin-coated stents was performed in 132 consecutive patients (98 males, with a mean age of 56.3+/-0.7 years) admitted with the diagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE), including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalization and the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 months following implantation. RESULTS: The angiographic and procedure success rate was 96.2%. During hospitalization, there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due to dissection. There were no bleeding complications. A six-month angiographic follow-up was completed in 47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical follow-up (mean follow-up period 37.2+/-7.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. The MACE free survival rate was 76.5%. CONCLUSION: Primary PCI, with heparin-coated stents, shows favorable long-term clinical outcomes.

The Effects of Platelet-Derived Growth Factor Inhibitor(Trapidil) on Intimal Hyperplasia Following Coronary Stenting: Assessed by Intravascular Ultrasound

BACKGROUND AND OBJECTIVES: Platelet-derived growth factor (PDGF) seems to be one of the most powerful factors associated with the proliferative process that occurs after percutaneous transluminal coronary angioplasty (PTCA), and leads to restenosis. Trapidil (Triazolopyrimidine), a potent inhibitor of PDGF, was shown to decrease restenosis after experimental balloon angioplasty. The aim of this study was to assess the effects of trapidil, on intimal hyperplasia, following coronary artery stenting, using volumetric intravascular ultrasound (IVUS) analysis. SUBJECTS AND METHODS: The patients were divided in 2 groups; Group I (n=14, age=53+/-8, male=11) received trapidil (600 mg) for 6 months, aspirin (200 mg) indefinitely and ticlopidine (250 mg) for 4 weeks, Group 2 (n=15, age=55+/-2, male=9) received aspirin (200mg) indefinitely and ticlopidine (500 mg) for 4 weeks, starting at least 3 days before the angioplasty. A serial IVUS study was performed post-stenting, with a 6 month follow up period. Both the stent (SA) and lumen areas (LA) were measured, and the stent (SV), lumen (LV) and intimal hyperplasia volumes (IHV) were calculated using Simpson's rule. RESULTS: The reference (RD), pre minimal luminal (MLD) and post minimal luminal diameters, as measured by quantitative coronary angiographic analysis (QCA), were not different between the two groups. Using serial IVUS measurements, SV and LV were not different between the two groups. Also, the IHV was not different between the two groups (51.9+/-26.1 and 61.3+/-25.3 mm3, respectively, p=NS). CONCLUSION: Trapidil failed to reduce intimal hyperplasia following coronary stenting compared with the controls.

A Retrospective Analysis on Reasons for Allograft Nephrectomy after Kidney Transplantation / 대한이식학회지

PURPOSE: Allograft nephrectomy has been done in considerable proportion due to many reasons after kidney transplantation. This study was undertaken to determine the incidence, causes, and time of allograft nephrectomy after kidney transplantation. METHODS: A total 141 kidney transplantations were performed between 1993 and 2003 Kyung Hee University Hospital. We found 22 cases of allograft nephrectomy in the same period and a retrospective analysis was conducted on 22 allograft nephrectomy. The patients records were reviewed for age, causes, and time of allograft nephrectomy after kidney transplantation. RESULTS: The pathological causes of allograft nephrectomy were chronic rejection in 18 cases (81.8%), acute rejection in 3 cases (13.6%), accelerated rejection in 2 cases (9.1%) and allograft infection, renal vessel thrombosis, cyclosporin toxicity, GVHD in each one case (4.5%). Of 18 cases with chronic rejection, acute rejection episode was occurred in 12 cases (66.7%). The interval from kidney transplantation to allograft nephrectomy was more than 5 years in most patients (63.6%). CONCLUSION: In our studies, allograft nephrectomy was performed in 22 cases, chronic rejection was major cause of allograft nephrectomy, and acute rejection episide was occurred in most chronic rejection. We suggested that early detection and aggressive treatment of acute rejection might be considered to lower the incidence of allograft nephrectomy after kidney transplantation.

Crawford Type III and IV Thoracoabdominal Aortic Aneurysm: 4 Cases Report

Thoracoabdominal aortic aneurysm is rare but potentially lethal, and its repair continues to present a surgical challenge because of obligate intraoperative visceral, renal, and spinal cord ischemia. In the past, the authors have experienced 4 cases of Crawford Type III and IV thoracoabdominal aortic aneurysm which were treated by a direct surgical approach. The diagnosis was made by CT scan, and aortogram. We repaired the thoracoabdominal aortic aneurysms with Knitted Dacron graft by a single inclusion button that encompasses the origins of the celiac, superior mesenteric, and right renal artery and left renal artery reconstruction with a separate side arm PTFE graft. the visceral ischemia time was less than 45 minutes in 3 operable cases and no paraplegia occurred after thoracoabdominal aortic reconstruction. two cases of Type IV thoracoabdominal aortic aneurysm with emergent presentation were fatal but elective surgical repairs of Type III and IV thoracoabdominal aortic aneurysm were survived. Appropriate patient selection and prevention of visceral or spinal cord ischemia may be helpful in the repair of Type III and IV thoracoabdominal aortic aneurysm.

Long-term Follow Up Results of Nonoperative Treatment for Critical Lower Extremity Ischemia

PURPOSE: Immediate revascularization is required for patients with critical lower extremity ischemia, but sometimes only nonoperative treatments are performed due to multilevel arterial occlusive lesions, poor outflow tracts, deteriorated general conditions, and severe associated diseases. We undertook this study to detrmine the long-term results of nonoperative treatments for patients with critical lower extremity ischemia. METHOD: From January 1992 to July 2002, among the patients with lower extremity arterial disease who visited the Department of Surgery at Kyung Hee Medical Center, 72 patients with critical lower extremity ischemia who had been treated with only conservative managements were chosen. Medical records were reviewed retrospectively and telephone interviews were performed. We assessed the functional outcome of the salvaged limb according to the recommended scale for gauging changes in clinical status, the 1997 revised version. RESULT: There were 63 men and 9 women (M : F=7 : 1), and mean age was 70.1 years. At median follow-up of 64.7 months, amputation rate was 27.8%, limb salvage rate was 71.9%, and the mortality rate was 20.8%. Cerebrovascular attacks (40%) and ischemic heart disease (27%) were the major causes of death. Underlying disease were diabetes (65.3%), hypertension (54.2%), ischemic heart disease (11.1%), and previous cerebrovascular attacks (13.9%). Clinical categories of involved patients were grade II (ischemic rest pain) in 80.5%, and grade III (tissue loss) in 19.5%. In survivors with limb salvage, functional outcomes were +3 in 12.5%, +2 in 26.8%, +1 in 35.7%, 0 in 23.2%, and -1 in 1.8%. CONCLUSION: The long-term results of this study suggest that nonoperative treatments for patients with critical lower extremity ischemia can achieve a higher limb salvage rate and significant improvements in the functional outcomes of salvaged limbs.

Clinical Experience of Cutting Balloon Angioplasty for in Stent Restenosis

BACKGROUND AND OBJECTIVES: A cutting balloon (CB) is a balloon catheter with 3 or 4 metal blades on its surface used for making controlled endovascular surgical incisions and promising minimal intimal injury. Some reports suggest advantages of the use of CB in the treatment of in-stent restenosis (ISR). The purpose of this study was to report the clinical experience of the use of CB for ISR. SUBJECTS AND METHODS: 28 patients were enrolled in this study. Angiographic success (defined by 40% residual stenosis), in-hospital, 30 days and 6 months clinical outcomes were evaluated. RESULTS: Angiographic success was 92.9% (26/28). The number of inflations and maximal inflation pressure were 2.8+/-0.9 and 10.1+/-1.3 ATM, respectively. The balloon/artery (B/A) ratio was 1.1+/-0.2. There was a case of stent insertion for treating type D dissection and a case of rotational atherectomy for suboptimal result after CB angioplasty. 25 cases underwent analysis through 6 months of clinical follow-up. During the 6-month clinical follow-up, 4 cases of re-PTCA were documented, while MACE during in-hospital time and the subsequent 30 days was 0%. CONCLUSION: Our experience demonstrated that CB can be performed safely and effectively in coronary ISR. Further clinical and angiographic effectiveness are warranted in a large-scale clinical trial.

Splenorenal Bypass for a Huge Left Renal Aneurysm

Renal artery aneurysms are rare, in less than 1% of consecutive abdominal aortograms. Renal artery aneurysms are bilateral in about 10% of cases. Controversy persists regarding the indications for repair of renal artery aneurysms and optimal method of repair. The authors report a case of left renal artery aneurysm with right renal atrophy in a 37-year-old male patient. This patient has no past medical history including hypertension. On physical examination, a pulsatile mass was palpated in left upper abdomen. Preoperative abdominal CT showed right renal atrophy and 8 cm diameter left renal aneurysm. Abdominal aortogram and left renal angiogram showed huge lobulated outpouching contrast collection at the proximal left renal artery without definite neck and diffuse irregularity at the proximal left renal artery. This patient was treated by splenectomy, thrombectomy, aneurysm resection and end to end splenorenal bypass. No remarkable postoperative complication was observed. The patient was discharged postoperative 12 days.

An Unusual Case of Guide Wire Fracture during Coronary Artery Stenting for Bifurcation Lesion

The complications associated with the use of a guide wire, used during angioplasy, are rare and often go unrecognized. However, occasionally the guide wire itself may cause serious complications such as perforation or dissection of the distal coronary artery. A guide wire fracture during angioplasty is a rare complication, however entrapment and uncoiling of the guide wire can cause fracture. We report a case of guide wire fracture that developed by entrapment of the distal bending portion during stenting for bifurcation lesion. The broken free end of the guide wire remained within the stent strut, and urgent surgical intervention was necessary for its retrieval. We experienced a case of entrapment and fracture of the guide wire during stenting that was successfully surgically removed.

The Effects of Vitamin B6 and Folate on The Level of Plasma Homocysteine and Brachial Artery Dilation in Healthy Subjects

BACKGROUND: Elevation in plasma homocysteine has been widely studied as an independent risk factor for atherosclerosis. And epidemiologic studies have demonstrated that the persons who take the folate and vitamin B6 have lower incidence of atherosclerotic vascular disease and lower plasma homocysteine level. But, not yet the effects of vitamin B6 and folate on the level of plasma homocysteine and brachial artery dilation on healthy subjects was not evaluated. METHODS: We evaluated the effects of 50 mg of vitamin B6 and 1 mg of folate on endothelial function, plasma homocysteine levels to one healthy postmenoausal woman and nineteen men in a randomized, double-blind, placebo-controlled, crossover design. RESULTS: In our study, supplement of vitamin B6 and folate significantly lowered plasma homocysteine level (placebo : folate =6.56 +1.55 micromol/L vs. 5.37 +1.04 micromol/L, p=.001). But, there were no statistically significant increament of flow-mediated dilation (FMD) compared to placebo (placebo : folate =5.12 +3.26% vs. 6.69 +2.60%, p=.070) and there were no significant correlation between the improvement of homocysteine level and increament of flow mediated dilation on healthy subjects. CONCLUSION: Compared to persons with absolute or relative hyper-homocysteinemia, our study did not show such favorable effects in healthy persons. So further studies must to be held to discover the effect of folate and vitamine B6 in healthy persons.

Long-term Outcomes of Primary Stenting in Acute Myocaridal Infarction

BACKGROUND AND OBJECTIVES: Primary coronary stenting has been shown to be an effective reperfusion therapy for acute myocardial infarction(AMI). However, few data exist regarding long-term follow-up. We examine the long-term clinical and angiographic outcomes after primary coronary stenting in the early setting of AMI. METHODS: Between September 1995 to October 1999, coronary stenting was attempted in 181 consecutive patients admitted with the diagnosis of AMI within 6 hours from the onset of the chest pain. Clinical events, including death, MI, coronary bypass surgery and repeat angioplasty, were recorded for 1 year. Angiogram were obtained at baseline, after stent, at 2 weeks and 6 months. RESULTS: 168 patients(92.8%) of all patients had complete 1 year clinical follow-up. In-hospital deaths occured in 5 patients(3%). One hundred five patients(62.5%) had follow-up angiography at 6.4+/-2.1 months after stent implantation and restenosis occured in 21.9%. Clinical events after 1 year included death in 6.5%, myocardial infarction in 1.2%, bypass surgery in 1.8% and repeat angioplasty in 7.7%. Freedom from any adverse cardiac event at 1 year was 82.2%. CONCLUSION: Primary stenting is safe and feasible in patients of AMI, even in large thrombus containing lesion and results in excellent long-term outcomes.

Functional Outcome of Surgical Management for Acute Lower Extremity Ischemia

PURPOSE: Despite simplification of operative techniques, high morbidity and mortality of patients presenting with acute lower extremity ischemia remain a challenge to the vascular surgeon. The purpose of this study is to assess the functional outcome of thromboembolectomy in acute lower extremity ischemia in addition to the technical success. METHOD: A retrospective review was conducted on 52 procedures in 42 patients presenting with acute lower extremity ischemia due to arterial thrombosis or embolism between Jan. 1992 and Feb. 2000, initially underwent thromboembolectomy. After initial thromboembolectomy, we assessed the functional outcome of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997. RESULT: There were 35 men and 7 women, the mean age was 64.5 years. Mortality rate was 16.7% and overall amputation rate was 16.7%, major and minor amputation rate were 28.5% and 4.8% respectively. Causes of acute lower extremity ischemia were embolic occlusion (26.9%), native arterial thrombosis (36.5%) and bypass graft thrombosis (36.5%). Underlying diseases were heart disease (48.1%), hypertension (23.1%), cerebrovascular accident (17.3%) and diabetes (11.5%). The sites of native arterial occlusion were aortoiliac (24.2%) and distal to femoral (75.8%). Clinical categories were grade I in 1.9%, IIa in 32.7%, IIb in 61.5% and III in 3.8%. The 1-month limb salvage rate was 61.9%. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 30.8%, +2 in 26.9%, +1 in 26.9%, 0 in 0.0%, +1 in 0.0%, +2 in 3.8% and +3 in 11.5%. CONCLUSION: Surgical approach to the management of acute lower extremity ischemia due to thromboembolism can achieve a significant rate of limb salvage. A new scale for gauging changes of clinical status in acute lower extremity ischemia is required to assess the functional outcome of the treatment of acute lower extremity ischemia.

Stenting of Extracranial Carotid Artery Stenosis

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Immediate and Follow-up Results of Stenting for the Small Coronary Artery Disease

BACKGROUND: Intracoronary stenting in large coronary artery with diameters >3 mm has been shown to be beneficial in the treatment of acute or threatened closures complicating balloon angioplasty and in the prevention of restenosis. However, whether equally favorable results are afforded by stent placement in small vessels (<3 mm) remains unclear. Accordingly, we evaluated the safety and feasibility of intracoronary stenting in native coronary vessels less than 2.75 mm in size. METHODS: Between January 1997 and July 1998, seventy eight patients with 81 lesions were treated with 83 stents, regardless of clinical setting. The angiographic criteria for enrollment included at least 70% stenosis and a vessel that reference diameter was less than 2.75 mm. Every patients received aspirin (300 mg qd, indefinitely) and ticlopidine (250 mg bid, one month) and was given a bolus dose of 10,000 U heparin during procedure. RESULTS: Angiographic success was achieved in 80 of 81 attempts (98%). There was one in-hospital death because of pump failure in AMI patient. There was no acute stent thrombosis. At 6 month follow-up, event free survival was achieved in 90% of patients and angiographic restenosis was found in 28% of patients (9/32). CONCLUSION: The present observational study demonstrates that angiography-guided stent placement in coronary artery < 2.75 mm in diameter is safe and effective in conjunction with current stent deplyment technique and antiplatelet protocol.

Stenting of an Anomalous Coronary Artery in Acute Myocardial Infarction

Single coronary artery is rare and the application of coronary angioplasty to these arteies presents unique technical challenge. As technical advances in the guiding catheter and balloon system occur, more challenging lesions including anomalous coronary artery are able to be treated. Correct guiding catheter selection is important to ensure adequate access to the anomalous vessel and provide support to cross the lesion. This report describes successful angioplasty with stent in right coronary artery of single ostium coronary anomaly in a patient presenting with an acute myocardial infaction.

A Case of Spontaneous Coronary Artery Dissection during Exercise Treated with Stenting

Spontaneous coronary artery dissection (SCAD) is a rare disease that occurs most commonly in young people, especially in peripartum or postpartum women. It is usually catastrophic and fatal. The etiology of dissection is still under discussion. Possible factors are inflammation, changes of flow dynamics, and preexisting intima lesions. The treatment of choice for spontaneous coronary artery dissection is still not settled. The authors report a twenty-nine year-old woman with coronary lesions diagnosed as spontaneous coronary artery dissection which developed during exercise and was treated with intracoronary stenting.

A Case of Transcatheter Alcohol Ablation of the Septum in a Patient of Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by inappropriate myocardial hypertrophy that occurred in the absence of an obvious cause for the hypertrophy and dynamic left ventricular outflow tract obstruction, caused by asymmetrical septal hypertrophy and systolic anterior motion of the anterior mitral leaflet. The pathophysiological abnormality in HOCM is diastolic dysfunction, abnormal stiffness of the left ventricle with resultant impaired ventricular filling and impaired vasodilator reserve (perhaps related to the thickened and narrowed small intramural coronary arteries found in HOCM). During the early course of this progressive disease, treatment consists of negative inotropic drugs. Surgery has been the only therapeutic option in patients with hypertrophic cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. We describe a novel catheter-based technique that may replace surgical myocardial reduction. The technique is interventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery.