Coronary aorto-ostial stenosis analysed by multislice computed tomography: a new tool for percutaneous coronary intervention?

AIMS: Conventional quantitative coronary angiography approaches are limited to quantify complex aorto-ostial stenosis. Multislice CT was able to detect and classify coronary plaques, compared with intravascular ultrasound (IVUS). The aim of the present study was to determine the accuracy of multislice computed tomography (CT) in addition to conventional angiography to identify aorto-ostial coronary stenosis characteristics before revascularisation. METHODS AND RESULTS: Patients with coronary ostial stenosis were selected for the study. All patients had selective coronary angiography and retrospectively ECG-gated multislice CT (Siemens AG, Munich, Germany). IVUS was performed in patients with ambiguous ostial stenosis revealed by angiography. Forty significant aorto-ostial lesions (38 patients) were analysed by two independent observers in comparison with an expert consensus blinded or not to the coronary CT data sets. Using CT in addition to angiography permitted observers to obtain a strong agreement for assessment of calcified lesions (kappa value 0.75), a good agreement for aortic plaques location and ideal stent position in aorto-ostial coronary stenosis. CONCLUSIONS: This study shows that CT associated with an angiogram allows a better identification of aorto-ostial plaques morphology and ideal stent position in aorto-ostial coronary stenosis before angioplasty.

Reduction in spasm with a long hydrophylic transradial sheath.

OBJECTIVES: We aimed to assess the efficiency of a long hydrophilic sheath in reducing radial spasm for transradial approach. BACKGROUND: Despite a lower access site complication rate, cardiac catheterization using transradial approach is not widely used. Radial spasm is one of the main issues for transradial angiography and percutaneous interventions. We assumed that radial artery protection using a long hydrophilic-coated sheath would reduce radial spasm compared to a bare short sheath. METHODS: Three hundred and fifty one patients (pts) admitted for transradial coronary angiography ± percutaneous coronary interventions were randomly assigned to a long hydrophilic-coated or a short sheath (control group). Primary end point was the occurrence of a radial spasm defined by significant patient pain evaluated by scale score (>4) or significant catheter frictions during manipulation. Procedure failure, radial occlusion, and local complications were also assessed. RESULTS: Radial spasm was significantly reduced when using the long-coated compared to the short sheath in 7 (4%) vs. 32 pts (18%) P < 0.001. No difference was found regarding procedure failure respectively 1.2% vs. 0.6%, local complication 0.6% vs. 1.2%, and radial occlusion 3.5% vs. 3.5%. CONCLUSION: Radial artery protection using the long hydrophilic-coated sheath was efficient in the prevention of radial spasm for transradial approach. © 2010 Wiley-Liss, Inc.

Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography.

OBJECTIVES: The goal of this study was to evaluate the diagnostic accuracy of 64-slice computed tomography (CT) to identify coronary artery disease (CAD) in patients with complete left bundle branch block (LBBB). BACKGROUND: Left bundle branch block increases risk of cardiac mortality, and prognosis is primarily determined by the underlying coronary disease. Non-invasive stress tests have limited performance, and conventional coronary angiography (CCA) is usually required. METHODS: Sixty-six consecutive patients with complete LBBB and sinus rhythm admitted for CCA were enrolled. Computed tomography was performed 3 +/- 3.9 days before CCA. The accuracy of 64-slice CT to detect significant stenosis (>50% lumen narrowing) was compared with quantitative coronary angiography. All segments were analyzed regardless of image quality from coronary calcification or motion artifacts. Results were analyzed by patient and by coronary segment (990) using the American Heart Association 15-segment model. RESULTS: Lower heart rates were associated with improved image quality. Computed tomography correctly identified 35 of 37 (95%) patients without significant stenosis and 28 of 29 (97%) patients with significant stenosis on CCA. Computed tomography correctly assessed 68 of 94 (72%) significant stenosis. Overall, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 64-slice CT for identifying CAD by patient was 95%, 97%, 95%, 93%, and 97%, respectively, and by segment was 97%, 72%, 99%, 91%, and 97%, respectively. CONCLUSIONS: In a routine clinical practice, 64-slice CT detects with excellent accuracy a significant CAD in patients with complete LBBB. A normal CT in this clinical setting is a robust tool to act as a filter and avoid invasive diagnostic procedures.

Comparison of coronary minimal lumen area quantification by sixty-four-slice computed tomography versus intravascular ultrasound for intermediate stenosis.

The present study assessed 64-slice computed tomographic accuracy to quantify minimal lumen area (MLA) and determine lesion severity in intermediate stenosis by angiography compared with intravascular ultrasound (IVUS). Sixty-four-slice computed tomography (CT) has been shown to be effective in coronary stenotic assessment by visual estimation compared with angiography. However, angiography is not an accurate gold standard for intermediate stenotic quantification compared with IVUS. Forty patients (54 lesions) with 30% to 70% coronary stenosis by angiography in a major coronary branch were included. All patients underwent quantitative angiography, retrospective electrocardiographically gated 64-slice CT (Siemens), and IVUS (40-MHz Atlantis; Boston Scientific). MLA was manually traced by 2 blinded and independent operators on 64-slice computed tomographic cross-sectional reconstruction and compared with IVUS MLA. A lesion was considered significant if the MLA was

Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo).

Myocardial dysfunction without coronary involvement may occur in acute cerebral diseases. We report 4 cases where, in the context of acute cerebral disorder, the echocardiograms revealed an extensive left ventricular circumferential akinesis except at the apex. Besides, for three of those cases no coronary disease has been highlighted. Recognition of such a pattern of LV dysfunction should lead to the search for an acute cerebral disease.

Transcatheter closure of traumatic ventricular septal defect: an alternative to surgery.

The incidence of ventricular septal defect (VSD) occurs in up to 4.5% of penetrating cardiac trauma. We report a patient with persistent VSD who underwent surgical repair with significant left-to-right shunt and signs of heart failure. We performed a successful transcatheter closure of the VSD with an Amplatzer septal occluder (AGA Medical Corporation; Golden Valley, MN).