Sealing of coronary artery aneurysm by using a new stent graft.

Coronary stenting has begun to play an increasingly important role in the management of coronary artery aneurysms. A case of successful and complete sealing of a coronary aneurysm by using a new stent graft is described. Further studies in a large patient population are required to confirm the safety and efficacy of this method. Cathet. Cardiovasc. Intervent. 48:96-99, 1999.

Intracoronary stent placement proximal to a myocardial bridge: immediate and long-term results.

The intracoronary stent placement in a lesion proximal to a myocardial bridge is of special importance and is considered to be a challenge for the interventional cardiologist. In this study 4 cases of stent implantation proximal to a coronary bridged segment are described. In all cases complications were observed after the procedure. The patients remained free of symptoms and the exercise TI201 test was negative for ischemia 8.5+/-2.6 months later. Although there is skepticism because of the abnormal coronary flow pattern, the endothelial dysfunction and the subsequent thrombogenicity, the stent placement proximal to a myocardial bridge was safe and with favorable long term results in all 4 cases. However, further studies in large populations are necessary.

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.

New method for placement of intracoronary stents in order to avoid their embolization in the intravascular space.

Stent dislodgment from the delivery catheter is a well-known complication of angioplasty with stent implantation. The aim of our study was to investigate the feasibility, effectiveness, and safety of a new technique of intracoronary stent implantation in order to avoid stent loss in the intravascular space. Fifty consecutive patients were candidates for angioplasty and stent placement. During angioplasty, a technique was followed according to which the guide wire "hindered" the dislodgment of the stent from the balloon catheter. Successful angioplasty and stent placement were performed in 46 out of 50 patients (92% success rate). In three cases of failure of stent implantation, the stent moved onto the balloon catheter; however, this was impeded by the guide wire. One non-Q-wave myocardial infarction occurred. No major complications (Q-wave myocardial infarction, CABG, or death) were observed. In conclusion, the technique applied was feasible enough, safe, and effective. However, the appropriate modification of its "hardware" will render it even more feasible and user-friendly.

Entrapment of angiographic catheter in the right coronary artery: a trap for the nonexperienced operator.

A case of angiographic catheter entrapment in the right coronary artery during coronary angiography in a patient with excessive tortuosity of the right iliac artery is described. Alternative manipulations in order to avoid this problem are presented.

Stent implantation in patient with visible intracoronary thrombus and compromised left ventricular function, after local thrombolysis using the Dispatch catheter.

The case of a patient with unstable angina and angiographic findings of significant (approximately 90%) right coronary artery stenosis with an intracoronary thrombus next to the lesion, total left anterior descending and circumflex occlusion and an ejection fraction of approximately 22% is described. The case was treated with stent implantation after local thrombolysis with the use of the Dispatch infusion catheter.

Successful management of right coronary air embolus after intracoronary administration of verapamil.

A case of a 50 year-old male with a coronary air embolism is described. The case was successfully treated with intracoronary administration of verapamil.

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.

Pressure-related ventricular tachycardia.

A case with syncope on exertion and paced heart block is presented. Non-sustained ventricular tachycardia was seen on Holter monitoring and reproduced repeatedly by either exercise or an injection of an alpha agonist, but not with provocative electrophysiology. Antihypertensive treatment using a beta-blocker with endogenous sympathomimetic activity prevented recurrences. It is suggested that this is a case of pressure-related tachycardia.