Angiographic and clinical outcomes following acute infarct angioplasty on saphenous vein grafts.

Acute infarct angioplasty on aortocoronary saphenous vein grafts (SVGs) poses significant challenges because of their degenerate morphology and presence of significant thrombus. Of 370 acute, primary, or rescue myocardial infarct angioplasties performed over 3 years, 21 (5.7%) were on SVGs in patients who had undergone previous coronary artery bypass grafting a mean of 7.2 years earlier. Mean duration of chest pain to start of intervention was 3.9 +/- 3.2 hours; 6 (29%) patients presented with cardiac shock and 4 had failed treatment with thrombolytic drugs. At intervention, 11 (52%) of the culprit SVGs were totally occluded. Flow was reestablished or improved in 18 (86%), but classified as Thrombolysis In Myocardial Infarction trial grade 3 in only 10 patients (48%). Distal embolization and "no reflow" occurred with a frequency of 57% and 71%, respectively. In-hospital mortality was 19%. At 6 months, freedom from death, repeat target vessel revascularization, or recurrent myocardial infarction was 55%. In 349 patients undergoing native vessel intervention, success and Thrombolysis In Myocardial Infarction trial 3 flow rates were seen in 95% and 73% of patients, respectively, and in-hospital mortality was 7.9%. This present study demonstrates that infarct angioplasty on culprit SVGs can be successful but is associated with higher rates of embolic complications and worse acute and long-term clinical outcomes compared with a parallel experience of acute infarct angioplasty on native coronary arteries.

Extraction of fully deployed coronary stents.

Coronary stents are often used because of their potential to improve the acute and long-term results of balloon angioplasty. The Palmaz-Schatz stent has been approved for use by the U.S. Food and Drug Administration largely because of a demonstrated reduction in the incidence of restenosis following its primary implantation. The Gianturco-Roubin design has been approved for use when balloon angioplasty results in threatened or acute vessel closure. In practice, both stent types are being used in settings when the results of balloon angioplasty are either potentially or actually unacceptable. In such circumstances it is imperative that stents be placed accurately and carefully. Occasionally, stent misplacement, embolization, or disruption can occur, and the need arises to recover and/or reposition the wayward prosthesis. This review describes the removal and recovery of fully deployed Gianturco-Roubin stents using an intracoronary snare technique.

Hapten resistant dextran induced ARDS reaction following intracoronary stent deployment.

A case of dextran induced adult respiratory distress syndrome is used to illustrate the most serious complication of dextran usage during intracoronary stent placement. This reaction occurred despite premedication with the hapten dextran 1. Mechanisms of dextran induced complications are discussed. A mechanism for hapten resistant dextran reactions is postulated. Suggestions to prevent such reactions are made.

Percutaneous transluminal angioplasty for shepherd's crook right coronary artery stenosis.

Angiograms from 1,043 consecutive patients undergoing right coronary artery angioplasty were reviewed to determine the incidence of "shepherd's crook" origin of the right coronary artery. Primary results, complications, and technical difficulties were compared with a control group. Fifty-one patients (4.9%) were found to have this anatomic variation. Compared with a control group, the primary success rate was lower (86% vs. 98%) and the incidence of procedural difficulties was higher (33% vs. 13%). Technical problems led to the use of more guiding catheters and more guidewires per patient than in the control group. Thus, coronary angioplasty of shepherd's crook right coronary artery imposes technical problems and is associated with less than an optimal primary success rate.