Measurement of radial artery spasm using an automatic pullback device.

Current evaluation of radial artery spasm (RAS), a frequent finding during the transradial approach for coronary angiography and angioplasty (TRA), is subjective. A quantitative measure of RAS will help in evaluation and comparison of management strategies. The objectives of the study were to assess the feasibility and safety of using an automatic pullback device (APD) for removal of transradial introducer sheaths and to establish a parameter to quantify RAS. In 50 consecutive transradial procedures, the APD was used to measure the force required for sheath removal. The mean maximal pullback force (MPF) was 0.53 +/- 0.52 kg (range, 0.1-3.0 kg). In 48 (96%) cases, the MPF was reached within the first 5 sec of pullback. All patients with clinical RAS (n = 4) had an MPF greater than 1.0 kg, while the remaining had an MPF less than 1.0 kg. All patients with severe pain during sheath removal (n = 3) had an MPF greater than 1.0 kg, while no patient with an MPF less than 1.0 kg had severe pain. It is feasible and safe to remove transradial introducer sheaths using the APD. The MPF is achieved within the first 5 sec of pullback and is a reliable parameter to quantify RAS. An MPF more than 1.0 kg correlates with clinical RAS and is associated with severe pain during sheath removal.

The elective use of the seven-cell NIR stent in coronary arteries < 2.75 mm in diameter: clinical and angiographic results at 6-month follow-up.

The outcome of interventional procedures has been improved by the use of coronary stents in vessels > 3.0 mm in diameter. We report a single-center prospective study of elective coronary stenting in 39 consecutive patients with de novo lesions and reference diameters < 2.75 mm. Seven-cell NIR stents were deployed with standard antiplatelet therapy, but without routine use of IIb/IIIa inhibitors or intravascular ultrasound. There was one case of acute stent thrombosis, but no cases of subacute thrombosis. The binary restenosis rate was 27.8% (10/36 lesions) and the target lesion revascularization rate was 19.4%. Symptoms improved markedly as judged by Canadian Cardiovascular Society and questionnaire scores and the use of antianginal therapy. This pilot study suggests that the elective use of coronary stents in vessels < 2.75 mm in diameter is safe with acceptable long-term results. A randomized trial comparing outcomes after stents and balloon angioplasty in small vessels is required.

In vitro validation of the luminal measurement of a novel catheter based moulding technique.

OBJECTIVE: To investigate a modified angioplasty balloon catheter, which uses a novel balloon polymer to produce luminal moulds. DESIGN: The catheter was tested in polyurethane phantoms of diameter 1.5 to 4.0 mm. Inflations were to 1.4 atmospheres for 20 seconds at 37 degrees C. The moulds were viewed by reinflating the balloon to 0. 34 atmospheres and quantified using macrophotography and caliper measurement. RESULTS: Evidence of systematic error was found with lumen diameters

Transcatheter embolisation of an enlarging acquired coronary arteriovenous fistula in a heart transplant recipient.

A 50 year old, recent cardiac transplant recipient developed systolic and diastolic murmurs but remained asymptomatic. The cause of the murmurs was not evident at transthoracic echocardiography. During routine left heart catheterisation a left anterior descending artery to right ventricular fistula was evident arising from the distal vessel and presumably acquired during routine endomyocardial biopsy. One year later, the patient remained asymptomatic but the calibre of the left anterior descending artery had increased and there appeared to be poor flow in to the proximal branches. The fistula was successfully treated by percutaneous deployment of two detachable embolisation coils in to the distal left anterior descending artery.