Stent entrapment and guide wire fracture during percutaneous coronary intervention in the same patient.

In the performance of increasingly complex PCI there remains an ever-present risk of stent entrapment and guide wire or other device fracture. We report the first case with stent dislodgement and guide wire fracture to occur simultaneously in the same patient.

Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control.

OBJECTIVE: Dual-source CT has excellent temporal resolution and allows good visualization of coronary vessels without heart rate control. Our aim was to evaluate the diagnostic performance of dual-source CT in the evaluation of coronary stent patency to determine whether the good temporal resolution would improve visualization of stents. SUBJECTS AND METHODS: Thirty-five consecutively registered patients (10 women, 25 men; mean age, 65 years) with 48 stents were examined prospectively without heart rate controlling agents. Observers evaluating image quality and patency of the stents were blinded to the results of invasive coronary angiography. In-stent restenosis was defined as more than 50% narrowing of the lumen. RESULTS: All stents were considered assessable for diagnosis with dual-source CT. In 85% (41/48) of the stents, image quality was good. Only two patent stents were misidentified as being stenotic. All other stents with stenosis and occlusion were correctly diagnosed. The sensitivity, specificity, positive and negative predictive values, and accuracy of dual-source CT in the detection of in-stent restenosis and occlusion were 100%, 94%, 89%, 100%, and 96%, respectively. The McNemar test result showed no statistically significant difference between the diagnostic performance of dual-source CT and that of invasive coronary angiography. The kappa indexes showed excellent intraobserver and interobserver agreement. CONCLUSION: The high temporal resolution of dual-source CT is helpful for evaluation of coronary stents without heart rate control. Further confirmation of our preliminary results may broaden the clinical indications for CT angiography as a diagnostic test for the exclusion of in-stent restenosis.

Contrast-enhanced 64-slice computed tomography in detection and evaluation of anomalous coronary arteries.

Anomalous coronary artery (ACA) has either an unusual origin or different anatomical course and is associated with sudden cardiac death. The absence or nonspecific symptoms of ACA make its diagnosis difficult. Mostly, ACA is diagnosed coincidentally during invasive coronary angiogram (ICA). A conventional computed tomography (CT) cannot provide detailed images of coronary arteries of the moving heart, but 64-slice CT, with its short acquisition time, can provide detailed anatomy of coronary arteries non-invasively. In this study, we assessed the validity of contrast-enhanced 64-slice CT in the evaluation of ACA. ICA was performed in 7,574 patients for the diagnosis or evaluation of occlusive coronary artery disease and detected coronary anomalies in 56 patients (0.7%). We then performed 64-slice CT in 53 patients out of the 56 patients with demonstrated or suspected coronary anomaly, showing the origin and the course of the ACA along with stenosis, except for one patient who could not be evaluated due to image distortion artifacts. Contrast-enhanced 64-slice CT was also performed in 374 patients with vague signs and symptoms, detecting coronary anomalies in 7 patients (1.2%). Thus, in the total of 59 patients undergone 64-slice CT, we were able to visualize the entire abnormal coronary tree with a high diagnostic image quality. This is the first study to demonstrate the utility of 64-slice CT in a large series of ACA. Contrast-enhanced 64-slice CT is superior to ICA to identify the presence and course of ACA and should be the first line diagnostic tool in the evaluation of ACA.

Detection of significant coronary artery stenosis with 64-section MDCT angiography.

PURPOSE: To prospectively evaluate the diagnostic performance of 64-section multidetector computed tomography (MDCT) to detect significant coronary artery stenosis using conventional coronary angiography (CCA) as the reference standard. MATERIALS AND METHODS: Institutional Review Board approval and informed consent were obtained. In this prospective study, 80 patients (61 male, 19 female, mean age 56) were examined. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. McNemar test was used to search for the significant difference between 64-section MDCT angiography and CCA to detect stenosis. Also, kappa index (kappa) for the agreement between MDCT angiography and CCA was calculated. RESULTS: The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for detecting significant stenosis were 96%, 98%, 91%, 99%, respectively. The sensitivity, specificity, PPV and NPV for classification of patients with or without CAD were 100% for all. McNemar test demonstrated no significant difference between 64-section MDCT angiography and CCA. Also, kappa index (kappa) indicated excellent agreement. CONCLUSION: Sixty-four section MDCT angiography is an effective diagnostic tool for the detection of significant coronary artery stenosis. Especially, the potential to differentiate patients with and without CAD may provide MDCT an important role in the prevention of unnecessary invasive diagnostic procedures.

[Arrhythmia risk and noninvasive markers in hypertensive left ventricular hypertrophy]. / Hipertansiyon ve sol ventrikül hipertrofisinde ventriküler aritmi riski ve noninvaziv aritmi göstergeleri ile iliskisi.

OBJECTIVE: Several studies have evidenced that hypertensive patients with severe left ventricular hypertrophy have an increased incidence of malignant ventricular arrhythmia and sudden death. However arrhythmia risk in mild to moderate hypertrophy is uncertain. This study aims to investigate the risk of ventricular arrhythmias in hypertensive patients with mild to moderate hypertrophy and evaluate the role of noninvasive arrhythmia markers and ambulatory blood pressures. METHODS: Ninety-nine hypertensive patients (35 male, mean age 57.3 +/- 9.6) without coronary heart disease were included the study. All subjects underwent an echocardiography for measurement of LV mass index (LVMI) and were classified in two groups; hypertrophic (LVH(+) n:43) and nonhypertrophic (LVH(-) n:56). Ambulatory blood pressure monitoring, 24 hour ECG, signal averaged ECG, and 12 lead ECG were performed in each group seeking to identify the arrhythmogenic risk. RESULTS: Holter ECG showed that 20.1% patients had Lown class II and 12.1% patients had Lown class IVa-IVb arrhythmia (potentially malignant ventricular arrhythmia; PMVA). PMVA incidence was significantly higher in hypertrophic groups (20.9%) compared to nonhypertrophic groups (6.5%) (p < 0.05). Ambulatory systolic and diastolic blood pressures were similar in PMVA(+) and PMVA(-) patients. At least two parameters of ventricular late potentials were significantly higher in LVH(+) group (25.7%) compared to LVH(-) group (4.9%) (p < 0.01). HRV parameters were not different between two groups. QTcd was significantly increased in LVH(+) than in LVH(-) patients (54.1 +/- 16.7 vs. 47.5 +/- 17.7 ms) (p < 0.05) The frequency of PMVA was significantly higher in increased QTcd compared to normal QTcd (24.3%-3.4%; p < 0.01) and LP(+) patients (16.2%) compared to LP(-) patients (8.7%; p < 0.05). CONCLUSION: Our data suggest that hypertension may be associated with high risk of PMVA in patients with mild to moderate LVH particularly in presence of LP and QTcd > 50 ms. QTcd and at least 2 factors of LP were increased in mild to moderate LVH. Arrhythmogenecity does not seem to be related with autonomic dysregulation and ambulatory blood pressure level in hypertensive patients.