Pericardial effusion as primary manifestation of Takayasu arteritis.

Takayasu arteritis (TA) is a chronic vasculitis, affecting young women in 80-90% of cases with greatest prevalence in Asians. As exudative pericarditis is an extremely rare, but a possible manifestation of TA, we report on a young women who presented with recurrent febrile pericardial effusion as primary manifestation of TA.

Percutaneous coronary intervention in patients with end-stage renal disease.

Patients with end-stage renal disease (ESRD) represent a growing number of patients in the cardiac catheterization laboratories worldwide. This is a consequence of the growing absolute number of ESRD patients in developed countries, better noninvasive diagnostic tools, better catheterization facilities and last-but-not-least better education of referring physicians about the incidence and prognosis of coronary artery disease (CAD) for patients with ESRD. There is growing evidence of the positive impact of coronary revascularization on long-term outcome of these patients. ESRD patients have a high comorbidity and are therefore better candidates for the less invasive approach using percutaneous coronary intervention (PCI) rather than coronary artery bypass surgery (CABG). From the view of the interventional cardiologist, ESRD patients represent one of the most challenging patient cohort concerning technical challenges and potential risk of complication for the patient. Percutaneous coronary intervention (PCI) including debulking techniques and stent implantation is the current standard therapy for patients with symptomatic single-vessel disease (SVD) and the preferred therapy for most patients with focal, polyfocal or even diffuse multi-vessel disease (MVD). Coronary bypass surgery is reserved for a decreasing number of patients with mechanically untreatable coronary lesions and unprotected left main stem stenosis. The problem of restenosis and subsequent target lesion revascularization has been decreased to a minimum by the use of drug-eluting stents (DES), even though prospective randomized trials including ESRD patients are lacking. In case of acute coronary syndromes, the need for immediate coronary angiography and subsequent revascularization by means of PCI should be pointed out.

Influence of different lipid-lowering strategies on plaque volume and plaque composition in patients with coronary artery disease: role of intravascular ultrasound imaging.

Lipid-lowering therapy has a significant impact on the prognosis and clinical course of coronary artery disease (CAD). Slowdown of plaque progression and plaque stabilization are the major cardiac goals of any lipid-lowering strategy. Until now, intravascular ultrasound imaging (IVUS) has been the only in vivo imaging modality which allows serial analysis of plaque burden and plaque composition on a volumetric basis. Several serial IVUS studies have shown that chronic statin therapy could decrease or even halt plaque growth. Moreover, aggressive lipid-lowering therapy using statins changes plaque composition over time. There is evidence that changes in plaque composition might explain the positive prognostic impact of statin therapy in patients with CAD. Beyond clinical endpoint studies, serial volumetric IVUS studies will become the standard to prove the efficacy of new lipid-lowering strategies in the future.