Research Update: Original Research Abstracts from The Journal of Invasive Cardiology, October 2005 December 2005

Clinical Experience with a Circumferential Clip-based Vascular Closure Device in Diagnostic Catheterization Hermiller J, Simonton C, Hinohara T, Lee D, Cannon L, Mooney M, O'Shaughnessy C, Carlson H, Fortuna R, Yarbrough CA, Zapien M, Chou T St. Vincent Hospital and Health Center, Indianapolis, Indiana BACKGROUND: The StarClose Vascular Closure System (Abbott Vascular Devices, Redwood City, California) utilizes a small, flexible nitinol clip to complete a circumferential, extravascular closure of the femoral arteriotomy site. The StarClose is an investigational device in the United States, limited by Federal law to investigational use. The StarClose is CE Mark approved. METHODS: The CLIP study was a prospective, randomized, multicenter trial utilizing a noninferiority design to compare the rate of major vascular complications and time-to-hemostasis using the StarClose system versus manual compression. A total of 596 subjects were enrolled, 208 of whom underwent diagnostic angiography. This diagnostic subset is the focus of this report. The primary safety endpoint was major vascular complications and the primary efficacy endpoint was time-to-hemostasis. All patients were followed at 30 days with a clinical exam. RESULTS: Subjects were randomized 2:1 to the StarClose (n = 136) or manual compression (n = 72). There were no major vascular complications in either group. Minor vascular complications occurred in 3 StarClose patients (2.2%), and 1 manual compression patient (1.4%) (p = 1.00). Use of the StarClose device reduced mean time-to-hemostasis from 15.47 ± 11.4 to 1.46 ± 4.5 minutes (p J Invasive Cardiol 2005 Oct;17(10):504-510. Early Discharge is Feasible Following Primary Percutaneous Coronary Intervention With Transradial Stent Implantation Under Platelet Glycoprotein IIb/IIIa Receptor Blockade: Results of the AGGRASTENT Trial Dirksen MT, Ronner E, Laarman GJ, van Heerebeek L, Slagboom T, van der Wieken LR, van der Wouw PA, Kiemeneij F Amsterdam Department of Interventional Cardiology, Amsterdam, The Netherlands BACKGROUND: Primary percutaneous coronary intervention (PCI) with stent implantation demonstrated to be superior to both PCI with balloon angioplasty and to thrombolysis for acute ST-elevation myocardial infarction (STEMI). The use of glycoprotein (GP) IIb-IIIa blockers in this setting may be beneficial. However, GP IIb-IIIa receptor blocker treatment is frequently accompanied by femoral entry site-related bleeding complications, resulting in additional morbidity and prolonged hospitalization. These complications are minimized by using the transradial approach (TRA). METHODS: This study prospectively explored the feasibility of early discharge (within 4 days) following primary PCI with transradial stent implantation under GP IIb-IIIa blockade with tirofiban in the setting of STEMI. One-hundred patients with STEMI eligible for PCI were included. RESULTS: Of these 100 patients, 62% received treatment according to the protocol, e.g., TRA, successful PCI with stent implantation, full-dose GP IIb/IIIa receptor blocker infusion and early discharge. The PCI was successful in 95%. Early discharge was achieved in 75 patients of the total study population. Major adverse cardiac and cerebral events (MACCE) did not occur in the early discharge group, with a 1-year event-free survival rate of 91%. The combined MACCE rates in the total study population at 1, 6, and 12 months were 8%, 15% and 20%, respectively. CONCLUSION: Early discharge is feasible following primary PCI with stent implantation via the radial artery under GP IIb-IIIa blockade for STEMI, however a larger study is needed to prove the efficacy of this strategy. J Invasive Cardiol 2005 Oct;17(10):512-517. Impact of Routine In-hospital Assessment of Low-density Lipoprotein Levels and Standardized Orders on Statin Therapy in Patients Undergoing Percutaneous Coronary Interventions Ahmad M, Schwalm JD, Velianou JL, Natarajan MK Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada BACKGROUND: Previous studies have shown that a significant proportion of patients undergoing percutaneous coronary intervention (PCI) are not receiving guideline-recommended statin therapy upon hospital discharge. We evaluated the impact of the implementation of routine cholesterol profile measurements and standardized orders post-PCI on the number of patients receiving statin therapy. METHODS: We conducted a prospective, observational study on all patients undergoing PCI in an urban teaching hospital from February 2002 to March 2003. Patient baseline characteristics, statin therapy pre- and post-PCI, and fasting lipid profiles were recorded as part of an ongoing PCI database. A similar cohort of patients undergoing PCI in the one-year time period immediately before the intervention was used as a comparison group. RESULTS: A total of 1,748 patients underwent PCI during the study period. Statin therapy was prescribed in 78% of patients pre-PCI and increased to 92% at hospital discharge. In the year before implementation of the standardized post-PCI orders, there was only a 5% absolute increase in statin use after PCI compared to a 14% absolute increase in the study time period (p = J Invasive Cardiol 2005 Oct;17(10):518-520. Nonocclusive Radial Artery Injury Resulting From Transradial Coronary Interventions: Radial artery IVUS Edmundson A, Mann T Wake Heart Research, WakeMed Heart Center, Raleigh, North Carolina OBJECTIVE: The purpose of the present study was to evaluate nonocclusive radial artery injury resulting from transradial access. BACKGROUND: The benefits of transradial access for coronary intervention have been well documented, but resulting intima-media hyperplasia could be a limitation. METHODS: Thirty patients undergoing transradial coronary intervention (Group A: 15 de novo procedures, Group B: 15 previous transradial procedures) underwent radial artery intravascular ultrasound (IVUS) before catheter insertion. IVUS abnormalities were evaluated in the 100 mm segment proximal to the access site using automatic pullback in the serial mode. A study segment was then selected for continuous cross-sectional recording to evaluate the effects of a spasmolytic cocktail on radial artery IVUS dimensions which were measured at baseline and at one-minute intervals after administration of 0.8 mg sublingual nitroglycerin (NTG) and 3 mg intra-arterial verapamil (V). Differences in the two groups were evaluated. RESULTS: Intimal hyperplasia and/or intima-media thickening was present in all patients in Group B. The baseline radial artery IVUS area was significantly smaller in Group B, despite the preponderance of males in this group (6.7 ± 0.8 mm2 Group A versus 5.0 ± 0.7 mm2 Group B; p J Invasive Cardiol 2005 Oct;17(10):528-531. A Randomized, Double-blind, Placebo-controlled Trial of Abciximab for Prevention of In-stent Restenosis in Diabetic Patients After Coronary Stenting: Results of the ASIAD (Abciximab in Stenting Inhibits restenosis Among Diabetics) Trial Chen WH, Kaul U, Leung SK, Lau YK, Tan HC, Leung AW, Lee MK, Li SK, Ng W, Lee PY, Lam KF, Tse HF, Lau CP Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China OBJECTIVES: Coronary stenting is associated with a high incidence of restenosis in patients with diabetes mellitus. Recent data suggest that diabetic patients treated with abciximab have a lower rate of target vessel revascularization (TVR). We sought to investigate whether abciximab can reduce in-stent restenosis after coronary stenting in diabetic patients. METHODS: In this prospective double-blind trial, we randomly assigned 254 patients with type 2 diabetes mellitus undergoing nonurgent coronary stenting to receive abciximab with an initial heparin bolus of 50 U/kg (n = 128) or placebo with an initial heparin bolus of 70 U/kg (n = 126). All patients received aspirin and clopidogrel before the procedure. The primary endpoint was angiographic restenosis by quantitative coronary angiography at 6 months. The secondary endpoint was death, myocardial infarction (MI), or target lesion revascularization (TLR) at 6 months. RESULTS: The clinical, angiographic, and procedural characteristics were matched between the 2 groups. Angiographic follow-up was completed in 226 patients (90%). Angiographic restenosis occurred in 29.1% of the abciximab group, and 24% of the placebo group (p = 0.30). The rates of the secondary endpoint were similar between the 2 groups (23.4% in the abciximab group versus 22.2% in the placebo group; p = 0.88). TLR was performed on 36 (18.4%) lesions in 29 (23.4%) patients of the abciximab group, and 26 (13.6%) lesions in 23 (18.3%) patients of the placebo groups, respectively (p = 0.21 and 0.35, respectively). CONCLUSION: Abciximab does not reduce angiographic restenosis or TLR in type 2 diabetic patients undergoing nonurgent coronary stenting. J Invasive Cardiol 2005 Oct;17(10):534-538. Release and Elimination of Soluble Vasoactive Factors During Percutaneous Coronary Intervention of Saphenous Vein Grafts: Analysis using the PercuSurge GuardWire distal protection device Salloum J, Tharpe C, Vaughan D, Zhao DX Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee BACKGROUND: The presence of no-reflow substantially increases the risk of major adverse clinical events (MACE) in percutaneous coronary artery interventions (PCI). Distal protection devices may eliminate both debris and soluble factors that can lead to no-reflow. This study was designed to evaluate the soluble factors released and eliminated by the PercuSurge GuardWire during SVG intervention. METHODS: Twenty-eight consecutive patients underwent PCI on 34 lesions in 31 SVGs using the PercuSurge GuardWire. Blood was taken prior to PCI for baseline measurement of: (1) vasoconstrictive factors: endothelin (ET) and serotonin (5-HT); (2) thrombotic factors: tissue factor (TF), plasminogen activator inhibitor (PAI-1), thrombin/antithrombin III complex (TAT), and prothrombin fragment F1+2 (F1+2); and (3) inflammatory factors: soluble CD40 ligand (sCD40L) and soluble E-selectin. After stenting and before deflating the distal protection balloon, 2 aspiration runs were performed with the PercuSurge Export Catheter and sent for analysis. RESULTS: Clinical follow-up was conducted at an average of 6 ± 3 months. SVG PCI resulted in a substantial increase in levels of vasoconstrictive factors, including ET (3 x increase; p J Invasive Cardiol 2005 Nov;17(11):575-579. Sirolimus-eluting Stent Treatment for Complex Proximal Left Anterior Descending Artery Stenoses: 7-month clinical and angiographic results Khattab AA, Otto A, Toelg R, Geist V, Klatt L, Richardt G Heart Centre Segeberger Kliniken GmbH, Bad Segeberg, Germany BACKGROUND: High-grade involvement of the proximal left anterior descending artery (LAD), either in isolation or as part of multivessel coronary artery disease, remains a frequent indication for surgical revascularization. This is particularly true in complex proximal LAD lesions among high-risk patients, since stenting is usually ineffective in the long term as regards freedom from angina and target vessel revascularization (TVR) in such patient subsets. The sirolimus-eluting stent (SES) has been reported to significantly reduce clinical and angiographic restenosis rates. We therefore analyzed the clinical and angiographic long-term results of a group of complex patients treated with SES for proximal LAD stenoses. METHODS: A total of 80 consecutive patients treated with sirolimus-eluting stents (SES) for complex proximal LAD stenoses were analyzed. This high-risk cohort included diabetic patients, long, bifurcated, ostial and heavily calcified lesions, chronic total occlusions and in-stent restenoses. Late lumen loss and clinically-driven target lesion revascularization (TLR) were analyzed at 7 months. RESULTS: Late lumen loss was 0.19 ± 0.06 mm in the analysis segment (stent with 5 mm proximal and distal to it) at 7 months. TLR was performed in 6.3% of cases, and the combined rate of death from any cause, nonfatal MI and TLR was also 6.3% at 7 months. CONCLUSION: SES, once successfully implanted into complex proximal LAD stenoses, appear effective, with rather acceptable rates of adverse events at 7-month follow-up. Accordingly, treating the proximal LAD using SES in complex patients may narrow the gap between PCI and surgery for this indication. J Invasive Cardiol 2005 Nov;17(11):582-586. Myonecrosis After Elective Percutaneous Coronary Intervention: Effect of clopidogrel-statin interaction Gulec S, Ozdol C, Rahimov U, Atmaca Y, Kumbasar D, Erol C Department of Cardiology, Ankara University Medical School, Ankara, Turkey BACKGROUND: A recent ex vivo study suggests that the metabolic activation of clopidogrel is catalyzed by cytochrom P450 (CYP) 3A4 and is competitively inhibited by atorvastatin, but not pravastatin. OBJECTIVE: To determine whether the incidence of procedure-related myocardial injury, assessed by cardiac troponin T (cTnT) release, is altered when clopidogrel is coadministered with a statin that is predominantly CYP3A4-metabolized. METHODS AND RESULTS: Of the 211 consecutive patients who underwent coronary stenting after pretreatment with clopidogrel, 114 were receiving a CYP3A4-metabolized statin (59 simvastatin and 55 atorvastatin, Group 1), and 37 were receiving a non-CYP3A4-metabolized statin (30 pravastatin and 7 fluvastatin, Group 2) whereas 60 patients were not taking any statins (Control). All were troponin-negative before the procedure. The overall incidence of postprocedural cTnT positivity (> 0.10 ng/ml) was 30.8%. Group 2 patients were less likely to exhibit cTnT rise relative to Group 1 patients (8% versus 41.6%; p = 0.004) and relative to controls (8% versus 32.5%; p J Invasive Cardiol 2005 Nov;17(11):589-593. Safety and Efficacy of a Multipurpose Coronary Angiography Strategy Using the Transradial Technique Sanmartin M, Esparza J, Moxica J, Baz JA, Iniguez-Romo A Unidad de Hemodinamica, Hospital Meixoeiro, Pontevedra, Spain The use of a single catheter for coronary angiography has a number of potential advantages such as the reduction of arterial trauma, costs and procedural time. Accordingly, we assessed the feasibility and safety of two different strategies for transradial multipurpose coronary angiography. METHODS: From February 2002 to December 2004, a total of 657 transradial diagnostic catheterizations were performed by a single operator in which engagement of both left and right coronary arteries was attempted either with a Judkins Left 3.5 (n = 194) or a Brachial Type K (n = 463) catheter. Success rates and complications were analyzed. RESULTS: The mean age was 64.4 ± 11.9 years. The right radial artery was used in 93% of the cases. Either left or right coronary angiography was possible in 94% of the Brachial type K cases, and in 97% of the Judkins Left cases (p = 0.11). Overall, a single-catheter procedure was possible in 87% of the cases (85% with Brachial Type K and 92% with Judkins Left 3.5; p = 0.01). There were no significant differences in fluoroscopy time (4.8 ± 3.8 minutes versus 5.0 ± 3.8 minutes; p = 0.61), or in dye volume (103 ± 33 ml versus 114 ± 78 ml; p = 0.15). There were no cases of femoral or contralateral arm crossover, and no coronary or aortic dissections or systemic embolization. CONCLUSION: A strategy of performing both left and right coronary angiography with a single Brachial Type K or Judkins Left catheter by the transradial technique is attractive and appears to be safe and effective. J Invasive Cardiol 2005 Nov;17(11):594-597. Poor Outcome in Patients Treated with Brachytherapy for Diffuse In-stent Restenosis: The role of additional stenting despite prolonged antiplatelet therapy Zavalloni D, Rossi M, Belli G, Scatturin M, Morenghi E, Marsico F, Catalano G, Tosi G, Pagnotta P, Presbitero P Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy BACKGROUND: Brachytherapy (IBT) has been the first effective treatment of in-stent restenosis (ISR). However, when IBT is associated with additional stenting, high rates of late thrombosis have been observed. Even though prolongation of a double antiplatelet therapy seems to have overcome this problem, studies analyzing whether additional stenting still remains a negative prognostic factor for restenosis are lacking. AIM: To evaluate outcomes of patients treated for ISR with or without additional stenting and IBT followed by prolonged antiplatelet therapy. METHODS: Seventy-seven consecutive patients treated with beta radiation in 89 lesions with ISR were analyzed according to the need for deploying additional stents: 73 lesions were treated without additional stents (Group 1) and 16 lesions with one or more new stents (Group 2) because of suboptimal results or flow-limiting dissections. Double antiplatelet therapy was administered for 12 months. An angiographic follow-up was scheduled after 6 months. P-values J Invasive Cardiol 2005 Nov;17(11):598-602. Coronary Artery Perforation During Percutaneous Coronary Intervention: Incidence and outcomes in the new interventional era Ramana RK, Arab D, Joyal D, Steen L, Cho L, Lewis B, Liu J, Loeb H, Leya F Division of Cardiology, Loyola University Medical Center, Hines V.A. Hospital, Maywood, Illinois BACKGROUND: Coronary artery perforation (CP) is a serious complication of percutaneous coronary intervention (PCI). We sought to define the incidence and outcome of CP given the advance in interventional techniques, devices and use of glycoprotein inhibitors (GP IIb/IIIa). METHODS: We retrospectively reviewed the records of patients who underwent PCI at our institution over a four-year period. The incidence of CP was derived from patient records and then confirmed by reviewing the angiogram. Perforations were classified as Type 1, 2, or 3, as previously defined. RESULTS: A total of 4,886 patients underwent PCI. Atherectomy devices were used in 329 patients and GP IIb/IIIa in 2,200 patients. Twenty-five CP were identified (0.5% incidence). Six were Type 1 (24%), 10 were Type 2 (40%), and 9 were Type 3 (36%). 13/25 (52%) of the CP were Type C Lesions, and 12/25 (48%) occurred in calcified vessels. All Type 1 perforations were caused by coronary wires and 4/6 CP occurred with the use of hydrophilic and extra stiff wires. Type 2 perforations were caused by coronary wires in 8/10 CP, and by stent deployment in 2/10. Two patients with Type 2 CP sustained a non-ST-elevation myocardial infarction. Type 3 perforations were caused by stent placement in 4/9 CP, 2/9 by atherectomy devices, and 3/9 by coronary wires. Four patients with Type 3 CP underwent pericardial drainage, 5 patients had a myocardial infarction and 2 patients died. CONCLUSION: Type 1 and 2 perforations are predominately caused by hydrophilic and stiff wires and do not require pericardial drainage or surgical intervention. Type 3 perforations are more often associated with stent and device use. A majority of Type 3 perforations can be initially managed by percutaneous methods. J Invasive Cardiol 2005 Nov;17(11):603-605. Failure of the Symbiot PTFE- covered Stent to Reduce Distal Embolization During Percutaneous Coronary Intervention in Saphenous Vein Grafts Blackman DJ, Choudhury RP, Banning AP, Channon KM Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom OBJECTIVES: To examine the effect of the Symbiot PTFE-covered stent on distal embolization during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). BACKGROUND: Covered stents are intended to trap friable debris and reduce distal embolization during vein graft PCI, but have consistently failed to improve clinical outcomes in randomized trials. The reasons for this lack of benefit are unclear. METHODS: Thirty patients undergoing SVG PCI, and eligible for a FilterWire distal protection device, were randomized to Symbiot or to a conventional bare-metal stent. Postprocedure, the FilterWire was removed, fixed in formalin, and photographed under high magnification. The primary end-point was embolic debris area, measured by semi-automated edge-detection analysis of digital images. Secondary end points were no-reflow, "Filter no-reflow", and distal embolization. RESULTS: There was no significant difference between the Symbiot and conventional stent groups in embolic debris area (10.5 ± 7.2 versus 6.6 ± 7.8 mm2; p = 0.18). No-reflow occurred in 3/14 Symbiot versus 0/16 conventional (p = 0.09), and final TIMI flow was lower in the Symbiot group (2.7 ± 0.5 versus 3.0 ± 0.5; p = 0.01). However, there was no difference in the incidence of Filter no-reflow (7/14 versus 7/16; p = NS) or distal embolization (9/14 versus 8/16; p = NS). Distal embolization in the Symbiot group occurred predominantly after postdilatation (7/9; p = 0.05). CONCLUSION: The Symbiot PTFE-covered self-expanding stent does not reduce distal embolization compared to a conventional bare metal stent. Distal embolization with the Symbiot occurs almost exclusively after mandatory postdilatation. These findings may explain the failure of the Symbiot, and of covered stents in general, to improve clinical outcomes during vein graft PCI. J Invasive Cardiol 2005 Nov;17(11):609-612. The Physics of Guiding Catheters for the Left Coronary Artery in Transfemoral and Transradial Interventions Ikari Y, Nagaoka M, Kim JY, Morino Y, Tanabe T Tokai University School of Medicine, Isehara, Kanagawa, Japan BACKGROUND: The backup force of a guiding catheter is important for successful percutaneous coronary intervention (PCI), however, no theory has been proposed thus far regarding the factors involved in its generation. METHODS AND RESULTS: The backup force of guiding catheters was measured in an arterial tree model. In vitro modeling showed that larger-sized guiding catheters had greater backup force (8 Fr > 7 Fr > 6 Fr). Comparing the backup force between transfemoral (TFI) and transradial interventions (TRI), it was found to be 60% greater in TFI with a Judkins L (JL) catheter, and 8% greater in TFI with a backup (EBU/XB) type catheter. However, the Ikari L (IL) catheter generated a similar backup force between TRI and TFI. In TRI, the Ikari guiding catheter showed the greatest backup force, especially in the power position (power position of IL4 > IL4 > backup type 3.5 > deep engagement of JL4 > JL3.5 > JL4). These findings were associated with the angle of the catheter on the reverse side of the aorta. We then constructed several catheters with varying contact lengths. In vitro modeling showed that a longer contact area increased the backup force. CONCLUSION: The present model showed that three factors were associated with backup force: (1) catheter size; (2) angle on the reverse side of the aorta; and (3) contact area. The Ikari guiding catheter comprises all of the preferable factors in TRI. J Invasive Cardiol 2005 Dec;17(12):636-641. Risk of Local Adverse Events Following Cardiac Catheterization by Hemostasis Device Use Phase II Tavris DR, Dey S, Albrecht-Gallauresi B, Brindis RG, Shaw R, Weintraub W, Mitchel K Food and Drug Administration, Center for Devices and Radiological Health, Division of Postmarket Surveillance, Rockville, Maryland OBJECTIVES: To assess the relative risks of serious local adverse events following cardiac catheterization by type of hemostasis device (versus manual compression controls) and gender. BACKGROUND: Reports to the FDA (U.S. Food and Drug Administration) of local vascular complications associated with the use of hemostasis devices following cardiac catheterization and resulting in serious injuries, raised concerns about the safety of these devices. Review of the medical literature also posed cause for concern. METHODS: Data were obtained from the American College of Cardiology-National Cardiovascular Data Registry, modified to suit the needs of this research. It included information from 59 institutions and 13,878 cardiac catheterizations performed during the last quarter of 2003. Multiple logistic regression, using 10 different outcomes, was used to assess the risk associated with type of device and gender, while controlling for demographic and physiologic variables, type of procedure, and several indices of comorbidity. RESULTS: Serious adverse events were reported in 3.37% of patients, the most common being bleeding with hematoma (2.00%). The adjusted odds ratio for women (compared to men) was 1.73 for any vascular complication. Only one hemostasis device, VasoSeal, demonstrated a high risk of any vascular complication compared to manual compression controls (OR = 2.38 [1.47-3.85; p = 0.0004]). This risk was mainly associated with diagnostic cardiac catheterization (OR = 3.36). CONCLUSION: VasoSeal appears to pose a greater risk for serious local vascular complications following cardiac catheterization than either manual compression controls or other hemostasis devices. Women have almost twice the risk of men for most local complications. J Invasive Cardiol 2005 Dec;17(12):644-650. Safety and Efficacy of the Percutaneous Radial Artery Approach for Coronary Angiography and Angioplasty in the Elderly Molinari G, Nicoletti I, De Benedictis M, Terraneo C, Morando G, Turri M, Anselmi M, Zardini P, Menegatti G, Vassanelli C Ospedale Civile Maggiore, p. le Stefani, Verona, Italy BACKGROUND: The transradial approach to coronary interventions has been accepted as a safe and effective alternative to the femoral approach due to fewer access site complications and improved patient comfort. In the present study we aimed to investigate the safety and efficacy of transradial procedure in the elderly. METHODS: We analyzed 850 patients who underwent transradial coronary angiography and/or angioplasty. All patients were divided into two groups, according to age. The first group consisted of patients J Invasive Cardiol 2005 Dec;17(12):651-654. Coronary Artery Stenting in Patients with Severe Left Ventricular Dysfunction Aslam F, Blankenship JC Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania PURPOSE: To assess the outcome of stenting in patients with severe left ventricular dysfunction, 149 consecutive patients undergoing coronary stenting with an ejection fraction less than or equal to 40% (mean 35 ± 10%) were analyzed. Angiographic and clinical success were achieved in all patients. At follow-up of at least 6 months (mean: 24 months), 130 patients (89%) were alive and 124 (85%) were less symptomatic than before percutaneous coronary intervention (PCI). We conclude that PCI can be performed safely in patients with depressed left ventricular ejection fraction and is associated with improved symptoms at long-term follow-up. J Invasive Cardiol 2005 Dec;17(12):656-658. Drug-eluting Stents Versus Repeat Vascular Brachytherapy for Patients with Recurrent In-stent Restenosis After Failed Intracoronary Radiation Chu WW, Torguson R, Pichard AD, Satler LF, Chan R, Porrazzo M, Kent KM, Suddath WO, Waksman R Washington Hospital Center, Division of Cardiology, Washington, D.C. Recurrent in-stent restenosis (ISR) following intracoronary radiation therapy (IRT) continues to be a therapeutic challenge. The present study aims to evaluate the clinical outcomes of patients who were treated with drug-eluting stent (DES) implantation versus repeat IRT for recurrent ISR after brachytherapy failure. A cohort of 88 patients who were previously treated with brachytherapy for ISR and presented with angina and recurrence of angiographic restenosis were evaluated for treatment with either DES [sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES); n = 34] or percutaneous coronary intervention (PCI) and repeat radiation (gamma or beta radiation; n = 54). The two groups had similar baseline clinical and angiographic characteristics. The in-hospital outcomes were similar between both groups. At long-term follow-up of 9.7 ± 4.1 months for the DES group and 10.3 ± 3.5 months for the repeat IRT group, there were no deaths or myocardial infarctions (MI). There was a trend toward more target vessel revascularization-major adverse cardiac events (TVR-MACE) in the DES group (p = 0.09). In addition, the patients in the DES group had a significantly lower survival rate compared to those in the repeat IRT group (p = 0.018). For patients who had recurrent ISR following IRT, either DES implantation or repeat radiation is safe and is associated with excellent immediate outcomes. Yet, at long-term follow-up, repeat IRT was associated with less recurrences and need for repeat revascularization when compared to DES implantation. Therefore, repeat IRT should be considered as an option for this difficult patient subset. J Invasive Cardiol 2005 Dec;17(12):659-662. Intravascular Thermographic Assessment in Human Coronary Atherosclerotic Plaques by a Novel Flow-occluding Sensing Catheter: A safety and feasibility study Belardi JA, Albertal M, Cura FA, Mendiz O, Balino PP, Padilla LT, Lauer M, Korotko J, O'Neill W Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina OBJECTIVE: To report the safety and feasibility of a new occluding thermographic catheter in patients with coronary artery disease. BACKGROUND: Although plaque temperature heterogeneity is shown in atheromatous plaques, significant underestimation is encountered due to the cooling effect of the uninterrupted blood flow. METHODS: The catheter was positioned at the stenotic site. Blood flow was interrupted by an expandable braid located at the distal portion of the catheter. Then, thermographic assessment was performed. RESULTS: In one patient, the catheter could not reach the lesion due to tortuosity. Of the 20 lesions evaluated, 5 were excluded due to unsuccessful interruption of blood flow. We identified 5 lesions with a 0.3 degrees Celcius elevations compared to the same site without interruption of blood flow. There were no procedural complications. CONCLUSION: The new catheter-occluding thermographic device, while avoiding the blood flow cooling effect, appears to be safe and feasible for the assessment of human plaque temperature heterogeneity. J Invasive Cardiol 2005 Dec;17(12):663-666.

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