Technical Feasibility and Early Clinical Outcomes Associated With Distal Filter Device Use for All Carotid Stenting Procedures

BACKGROUND AND OBJECTIVES: Distal filter devices (DFDs) are known to reduce the occurrence of embolic events by capturing embolic debris and thereby preventing intracranial embolization during carotid artery stenting (CAS). However, there are few reports addressing DFD use in CAS procedures. Therefore, we evaluated the technical feasibility and clinical outcomes associated with DFD use in all CAS procedures. SUBJECTS AND METHODS: Between June 2004 and June 2008, all CAS procedures performed at our center were completed with DFD protection. We recorded periprocedural data and watched for new neurologic abnormalities for 24 hours after the procedure. One-month clinical outcomes were also evaluated. RESULTS: A total of 100 carotid lesions in 94 patients (age 68+/-8 years; 79 men) were treated with percutaneous stenting using DFDs (FilterWire EZ(TM), Boston Scientific Co, US). DFD application was successful in all procedures. Periprocedural strokes occurred in five procedures (one major, one minor, and three transient ischemic attacks). The one-month rates of stroke and death were 6% and 2%, respectively. Difficult filter placement occurred in two procedures due to tight stenosis and severe common carotid artery (CCA)-to-internal carotid artery (ICA) angulation. Difficult stent delivery occurred in three instances: one due to severe lesion calcification and two due to proximal tortuosity. The retriever failed to acquire the filter in nine procedures. Four of nine retrieval difficulties were related to severe CCA-ICA angulation. CONCLUSION: DFD use was successful in all CAS procedures, was relatively safe, and had few periprocedural complications.

The Clinical Feasibility of Transradial Primary Percutaneous Coronary Intervention with an ST Elevation Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: With the lower incidence of bleeding complications and earlier ambulation, transradial coronary intervention (TRI) is related with improved patient satisfaction compared with that of conventional transfemoral intervention (TFI). However, there is insufficient data about the efficacy of TRI in patients with an acute ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of TRI in selected patients with an acute STEMI. SUBJECTS AND METHODS: Between March 2003 to August 2006, 386 acute STEMI patients were treated using primary percutaneous coronary intervention (PCI), of which 335 had undergone TRI and were included in the study. This study was performed retrospectively on 335 consecutive patients, including 246 males, with a mean age of 62+/-11 years. RESULTS: Hemodynamically stable patients (n=335) underwent primary PCI via TRI. Fourteen of the TRI cases were changed to the TFI group during the procedure. The procedural success rate was 96%. The mean time interval from arterial access to balloon dilatation and total procedure time were 13.4+/-7.1 and 37+/-18 min, respectively. A 6 French sized guiding catheter was used in 235 cases (70%). There were no major bleeding complications, and the mean duration of hospital stay was 4.7+/-4.9 days. CONCLUSION: In the setting of primary PCI, TRI can be a feasible and safe approach in selected hemodynamically stability patients.

The Clinical Feasibility of Transradial Coronary Intervention in Selective Patients Undergoing Left Main Coronary Intervention

BACKGROUND AND OBJECTIVES : The transradial approach has been increasingly used as an alternative to conventional transfemoral intervention. However, there is little data on the efficacy of transradial coronary intervention (TRI) in left main coronary arterial (LMCA) disease. The purpose of this study was to evaluate the feasibility of TRI in selective patients undergoing percutaneous coronary intervention (PCI) for LMCA disease. SUBJECTS AND METHODS : Between Jan 2003 and May 2005, 83 patients with LMCA stenosis were treated with PCI. Of these, 40 selected patients having undergone TRI were included in this study. RESULTS : The patients included 30 males and 10 females, with a mean age of 61+/-12 years. There were 28 cases (70%) involving coronary arteries other than the LMCA and 24 cases (60%) with bifurcation lesion involvement. In 28 cases (70%), a 6 Fr sized guiding catheter was used. No case required crossover from TRI to TFI due to procedural failure. During hospitalization, 2 patients who underwent primary PCI in the setting of STEMI died, but there were no other clinical events. CONCLUSION : In selected patients with LMCA disease, TRI can be a feasible and safe approach for PCI.

A Case of Severe Midventricular Obstructive Hypertrophic Cardiomyopathy with Apical Aneurysmal Dilatation

Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.