Dec-07

This issue of the Journal of Invasive Cardiology includes original research articles, a Rapid Communication selection, as well as the third update of The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report to help clinicians incorporate the 2007 ACC/AHA Guidelines into their treatment protocol. Also, please visit our digital issue to view this month’s case reports and an index to all articles published during 2007 in the Journal (www.invasivecardiology.com).
The first two research articles, both from the Cardiovascular Research Institute/Medstar Research Institute at Washington Hospital Center, Washington, D.C., and the Cardiovascular Research Foundation in New York, employ intravascular ultrasound (IVUS) as a tool to explore the treatment issues around left main coronary artery disease (CAD) and in-stent restenosis (ISR). The first, submitted by Young Joon Hong and associates, describes the impact of remodeling on cardiac events in patients with angiographically mild left main CAD. Using IVUS, the authors found that angiographically mild left main disease was more frequently associated with negative remodeling, and negative remodeling was associated with fewer left main artery-related cardiac events. In the second article, Dr. Sang-Wook Kim and colleagues present their study using IVUS to investigate the clinical outcomes of recurrent ISR lesions treated with repeated stenting. They found that successive stenting of recurrent ISR lesions was not associated with a decrease in minimal stent area, but rather with chronic stent underexpansion and a high rate of adverse events.
Drs. Sergey Yalonetsky and Avraham Lorber from the Department of Pediatric Cardiology and GUCH Service, Rambam Healthcare Campus, Technion Faculty of Medicine in Haifa, Israel, describe their study of percutaneous closure of a secundum atrial septal defect in elderly patients. They found that in the absence of severe left ventricular dysfunction, the transcatheter approach provides acceptable results in patients who are older than 60 years of age at the time of treatment. Dr. Satinder Sandhu, from the University of Miami, has provided a commentary to accompany this article.
In the next original research article, Dr. Akiyoshi Miyazawa and colleagues from the Center for Cardiovascular Technology, Stanford University Medical Center, in Stanford, California, describe an analysis to compare the morphology of late incomplete stent apposition accompanying bare-metal stenting (BMS), intracoronary radiation and sirolimus-eluting stents (SES) using serial IVUS. They found that plaque reduction primarily contributes to late incomplete stent apposition after BMS, whereas vessel expansion is the primary factor for intracoronary radiation and SES.
In the last original research article, Dr. Fuminobu Yoshimachi and colleagues from the Aomori Perfectural Central Hospital, Aomori, Japan and Hyogo Medical College, Tokai University School of Medicine and Shonan Kamakura General Hospital, present data from in vitro trackability tests and experiments in a porcine model to demonstrate the feasibility of using a kissing balloon technique through a 5 Fr guiding catheter with a 0.010 inch guidewire and 0.010 inch guidewire-compatible balloons. The authors also report on the first clinical case of protected left main bifurcation treatment using the kissing balloon technique with a 5 Fr guiding catheter.
This issue of the Journal offers a CME article on the pharmacoinvasive management of acute coronary syndrome and incorporates the 2007 ACC/AHA Guidelines (The Cardiac Catheterization and Antithrombotic Therapy in the Hospital Clinical Consensus Panel Report III). The authors, Dr. Marc Cohen of Newark Beth Israel Medical Center and collaborators from Baylor, Brigham and Women’s Hospital, Duke Clinical Research Institute and the Texas Heart Institute, provide an updated review of the medical and invasive management of patients with NSTE-ACS and STEMI, as supported by recent updates to the ACC/AHA Guidelines. Their review summarizes findings from the most important recent clinical trial results and offers concise recommendations.
Dr. Samir Pancholy from Mercy Hospital and Community Medical Center in Scranton, Pennsylvania, has submitted an article on a novel approach using transradial access in an occluded radial artery for the Rapid Communication special section. This technique promises to provide more options for accessing the proximal circulation from an occluded radial artery.
This issue of the Journal also includes case reports that are published exclusively online. First, Dr. Jason Lindsey and colleagues from the University of Texas Southwestern Medical Center, Dallas and the VA Medical Center in Dallas, Texas, describe their successful use of a second buddy wire to treat a left main lesion in which an underexpanded stent resisted all other forms of therapy. Next, Drs. Otsuka, Kasahara and Kawamura from the National Cardiovascular Center in Suita, Osaka, Japan, have provided a description of their approach using the SafeCut balloon for treating ISR of a previously underexpanded SES with a heavy calcified plaque.
In the next case report, Dr. Goldberg and colleagues from the Heart Institute, Sieff Government Hospital in Safed, Israel, report their approach to using a buddy wire and buddy balloon to treat a very difficult lesion. Drs. Kapur, Conte and Wittstein from the Johns Hopkins University School of Medicine in Baltimore, Maryland, present their approach using both transesophageal echocardiography and coronary angiography to detect and successfully treat a patient with an unruptured mycotic coronary aneurysm.
Drs. Ponnuthurai, Gaal, and Channon from John Radcliffe Hospital in Oxford, United Kingdom, present an unusual case of focal ISR and in-stent thrombosis occurring within the same BMS 5 years after deployment in a saphenous vein graft. In the next case report, Dr. S. Ramamurthy and colleagues describe a patient who presented with an inferior myocardial infarction that was complicated by persistent heart block, which was ultimately treated with PCI without the need for a permanent pacemaker.
Next, Drs. Vaseghi, Lee and Currier from the UCLA Cardiac Catheterization Laboratory, David Geffen School of Medicine in Los Angeles, California, report on a case of acute myocardial infarction secondary to left main coronary artery compression by a pulmonary artery aneurysm in pulmonary arterial hypertension. Drs. Daka, Khan and Deppert from St. Luke’s-Roosevelt Hospital Center in New York and the Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania, present their management of a patient who presented with transient left ventricular apical ballooning after a cocaine binge. In the last case report, Dr. Jack Chen from St. Joseph’s Hospital in Atlanta, Georgia, describes a patient who had very late stent thrombosis and who presented in cardiogenic shock almost 4 years after initial stent placement and over 2 years after discontinuation of clopidogrel.
And finally, we have assembled an Index of Articles published in the Journal in 2007, which appears in the digital issue.
It is my hope that the articles in this issue of the journal provide cardiovascular healthcare professionals with important information that assists them in the effective daily management of cardiac patients.