Two Cases of Successful Primary Percutaneous Coronary Intervention in Patients With an Anomalous Right Coronary Artery Arising From the Left Coronary Cusp

An anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital anomaly. Because of the unusual location and the noncircular luminal orifice of this anomaly, cannulation of this artery during coronary angiography and percutaneous coronary intervention (PCI) poses significant technical difficulties when using the currently available guiding catheters. Primary PCI should be performed as quickly as possible when a patient displays this condition. When we face the situation of an anomalous artery during primary PCI, it takes a much longer time to open the occluded artery. We report here on two cases of successful primary PCI with using manually manipulated catheters and Ikari type guiding catheters in 2 patients who both had an anomalous RCA arising from the left coronary cusp.

The Feasibility of Percutaneous Transradial Coronary Intervention for Chronic Total Occlusion

We evaluated the feasibility of the transradial coronary intervention (TRCI) in 85 consecutive patients with chronic total occlusion (CTO). Clinical, angiographic and procedural factors were compared between the success and failure groups. An overall success rate of 65.5% (57 of 87 lesions) was achieved with TRCI, and the most common cause of failure was an inability to pass the lesion with a guidewire. A multivariate analysis demonstrated that the most significant predictor of failure was the duration of occlusion (OR 1.064 per month, 95% CI 1.005 to 1.126, p = 0.03). The procedural success rate improved with use of new-generation hydrophilic guidewires. The 6 Fr guiding catheters were used in the majority of the 70 cases (81%). Five cases were crossed over to a femoral artery approach due to engagement failure of the guiding catheter into the coronary ostium because of severe subclavian tortuosity and stenosis in two cases, radial artery looping in one case, and poor guiding support in two cases. There were no major entry site complications. In conclusion, the radial artery might be a feasible vascular route in coronary interventions for CTO, with comparable procedural success and no access site complications.

Reconsideration for current guideline of lipid-lowering therapy in patients with coronary artery disease

BACKGROUND AND OBJECTIVES: Despite the proven benefit of cholesterol- lowering therapy in patients with CAD, there is no consensual opinion on guideline of cholesterol-lowering therapy in patients with CAD in Korea. The aim of this study is to evaluate the risk of CAD according to the cholesterol level and to consider current guideline of cholesterol-lowering therapy for the secondary prevention in patients with CAD. MATERIALS AND METHODS: Consecutive 600 patients were assigned into two groups - coronary artery disease group (364 patients) and normal coronary artery group (236 patients) - depending on the coronary angiographic findings. Lipid profiles (total cholesterol, Triglyceride, HDL-cholesterol, LDL-cholesterol) were obtained and the odd ratio of CAD was evaluated according to the national cholesterol education program treatment guideline (NCEP: LDL cholesterol > or = 130 mg/dl) and the national heath insurance treatment guideline (NHI: total cholesterol > or = 220 mg/dl) by multi-variate logistic regression analysis. RESULTS: According to the NHI and NCEP guideline, the proportion of patients with CAD indicated on cholesterol-lowering therapy were 25%, 36.5% respectively and the odd ratio of CAD was 1.00 (95% CI 0.52 - 1.89, p=0.99), 4.89 (95% CI 2.78 - 8.60, p or = 130 mg/dl only reflected the risk of CAD in both guidelines and more proportion of the patients were indicated on cholesterol-lowering therapy in NCEP guideline than in NHI guideline.