Elective intracoronary Micro-Stent II implantation without quantitative coronary angiography or intravascular ultrasound guidance and without subsequent anticoagulation: short- and long-term results.

Intracoronary stenting has been shown to reduce acute closure and restenosis rate in patients treated with coronary angioplasty. The use of high inflation pressures and intravascular ultrasound guidance allowed the substitution of anticoagulants with antiplatelet agents but increased the cost. The aim of this study was to investigate the effectiveness, safety, and long-term outcome of the elective implantation of a relatively new type of stent (Micro-Stent II), without the use of quantitative coronary angiography or intravascular ultrasound guidance and without subsequent anticoagulation. The study included 361 patients who underwent elective microstent implantation. Stent expansion was performed at 8 atm followed by higher inflation pressure at 14-20 atm. Heparin was given intraarterially only once immediately after the arterial sheath insertion. Ticlopidine was started at least 48 hours before the procedure and continued for 1 month while aspirin was continued indefinitely. All patients were followed up for 12.9 +/- 3.6 months. Short term outcome (first month): Stent implantation was successfully achieved in 361 of 366 patients (98.6%). Seven patients (1.9%) were excluded from the study and received anticoagulants because of a suboptimal result. In total, 423 stents were implanted. There was no subacute thrombosis, but acute vessel closure occurred in one patient (0.3%). Non-Q wave myocardial infarction occurred in six patients (1.7%), Q wave myocardial infarction occurred in one patient (0.3%), and only one death (0.3%) of nonischemic origin was reported. No major peripheral vascular complications were observed. Late results: Q or non-Q wave infarction occurred in 13 patients (3.6%), 26 patients (7.2%) underwent a repeat angioplasty, eight patients (2.2%) underwent coronary artery bypass grafting, and four patients (1.1%) died. Overall, 284 patients (78.7%) were free of symptoms, while 77 (21.3%) had recurrent coronary ischemia. In conclusion, Micro-Stent II implantation without quantitative coronary angiography or intravascular ultrasound guidance and without anticoagulation was found to be effective, safe, and with good long-term outcome.

Angioplasty followed by coronary stenting at the anastomotic site of saphenous vein bypass graft with the native vessel: a case that needs special procedural strategy.

In this report we describe a case in which a saphenous vein graft stenosis at the site of anastomosis with the left anterior descending artery (LAD) was dilated with a special Controlled Angioplasty Technology (CAT) balloon, and then stented. Balloon angioplasty and stenting at the site of anastomosis represents a technical problem because of diameter discrepancy and needs special attention in order to avoid minor or major complications.

Angioplasty without the use of "Y connector": a new, easier, bloodless method.

The "Y connector" that is used in angioplasty has the following disadvantages: 1) it is not blood-tight; 2) we need to "screw and unscrew" every time we want to inject contrast material or measure the pressure; and 3) it does not allow the advancement of the guidewire or the balloon catheter during the injection of contrast material. We created a new type of connection composed of a cut sheath for the femoral artery, connected with a cut (at the "hub") guiding catheter. The aim of this study was to examine the feasibility, efficacy, and safety of the new method. Using the new technique we performed plain-balloon angioplasty, implantation of stent, and atherectomy in 350 patients. The technical success of the method was 100%, and no complications related to the method were seen. In conclusion, the novel connection that we created eliminated all the disadvantages of the "Y connector" and was found to have 100% technical success and safety.

Communication between a nongrafted left internal mammary artery and left anterior descending coronary artery following saphenous vein bypass grafting.

A case is described in which a pericardial branch of a nongrafted left internal mammary artery communicated directly with the distal left anterior descending artery, following saphenous vein bypass grafting. This type of collateralization following coronary artery bypass surgery seems to be very rare, and perhaps could protect the myocardium from severe ischemia.

Cortical blindness following coronary arteriography: a rare but self-cured complication. Two case reports.

The rare and self-cured complication of cortical blindness following coronary arteriography is presented in 2 patients who underwent cardiac catheterization. Both patients were submitted to an aortocoronary bypass grafting procedure a few years before and were under clinical investigation for a new onset of unstable angina pectoris.

Single coronary artery from the right sinus of Valsalva, associated with absence of left anterior descending and an ostium-secundum-type atrial septal defect: a rare combination. A case report.

A case of single coronary artery from the sinus of Valsalva, with an anomalous origin of the left circumflex coronary artery from the just proximal portion of the right coronary artery, absence of the left anterior descending, and an ostium-secundum-type atrial septal defect is presented. This combination seems to be very rare.

Coronary angioplasty in the elderly: immediate and long-term results.

Coronary angioplasty was performed in 37 elderly patients (> sixty-eight years) with unstable or stable angina, refractory to medical treatment. History of myocardial infarction was present in 38% and of previous bypass surgery in 5% of patients. Coronary angiography revealed single-vessel disease in 22 (59%) and multivessel disease in 15 (41%) of patients. The mean left ventricular ejection fraction was 53 +/- 17%. Percutaneous transluminal coronary angioplasty (PTCA) was successful in 92% of patients; there were two angioplasty failures and 1 acute occlusion leading to Q wave myocardial infarction. In patients with multivessel disease complete revascularization was achieved in 33%. Follow-up data (21.29 +/- 9.23 months) are available in all patients with primary angiographic success. There was 1 death. Seventy-nine percent of patients had an improved anginal status, and repeat PTCA was performed in 2 patients because of clinical recurrence. Thus, coronary angioplasty is a safe and efficacious method of revascularization in symptomatic patients over the age of sixty-eight years.

Double left anterior descending artery originating from the left and right coronary artery: a rare coronary artery anomaly.

A case of double left anterior descending coronary artery is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly of coronary arteries seems to be very rare.

Ventricular extrasystolic arrhythmias in exercise testing. II. Haemodynamic correlations.

Exercise testing (ET) has been used for assessing the arrhythmogenic tendency of myocardium in patients (pts) with coronary heart disease. It has been suggested that coronary patients with left ventricular (LV) dyssynergy are prone to present ventricular extrasystolic arrhythmia (VA) during ET. We studied the functional status of the LV in a group of 25 coronary patients who presented VA during ET (Group A), and compared the results with a group of 87 patients without VA during ET (Group B). No statistically significant difference was found between the two groups in end-diastolic pressure, ejection fraction, and extent of dyssynergy of the LV. Furthermore, no significant difference was noted in the extent of development of the collateral circulation.

Anomalous origin of the right coronary artery arising from the circumflex artery.

A case of anomalous origin of the right coronary artery discovered among 3100 selective coronary arteriograms is described. This artery was arising from the circumflex artery. The position, distribution, and configuration of this coronary artery was as a normal right coronary artery, except that its origin was in the peripheral segment of the circumflex artery. This anomalous origin is very rare and seems not to give rise to any clinical significance.