Editorial Message (September 2004)

This issue of The Journal of Invasive Cardiology, which coincides with the Annual Transcatheter Cardiovascular Therapeutics (TCT) meeting, includes original research articles, case reports, reviews, articles from the journal special sections Peripheral Vascular Disease, Clinical Decision Making, The Electrophysiology Corner, Clinical Images, Practice Management, and a Continuing Medical Education offering. The first research article, submitted by Dr. Abid Asali and associates from Tel Aviv University in Tel Aviv, Israel evaluates two approaches to using stents in bifurcation lesions, one being single stenting in the main branch while ballooning the side branch and the other involving stenting of both branches. They found that although initial success was lower in the single stent/balloon group, longterm outcomes were significantly better in the single stent/balloon group compared to those that received two stents. In the next original article, Dr. Joseph Stella and colleagues from the Heart Care Centers of Illinois in Blue Island, Illinois present their study of the effectiveness of using bivalirudin in conjunction with PCI in the treatment of patients presenting with ST elevation MI. They found that patients had low rates of mortality and complications and suggest that further study with larger controlled trials is needed. In the next original research paper, Dr. Christodoulos Stefanadis and collaborators from Hippokration Hospital, Athens Medical School in Athens, Greece present their experiment to determine if blood flow through coronary arteries has a cooling effect on the heart. Their study demonstrated that complete occlusion of blood flow with balloon dilatation caused an increase in blood temperature. They discuss the implications of these findings on our understanding of the pathophysiology and treatment of coronary artery disease. In the next original research article, Dr. Dale Tavris and colleagues from the Food and Drug Administration and the American College of Cardiology have provided an analysis of the American College of Cardiology National Cardiovascular Data Registry examining the risks of serious local adverse events following cardiac catheterization comparing the use of hemostatic devices versus manual compression. They found that women had significantly more bleeding events compared to men and that certain closure devices had a protective effect in relation to the occurrence of local complications. Drs. Ruchira Glaser and Howard Herrmann have provided a commentary to accompany the Tavris et al. article, focusing on explanations of the increased bleeding rate in women and questions that remain to be answered. In the next research article, Dr. Jim Man-Hong and associates from Queen Mary Hospital in Hong Kong present their study of 1532 patients to determine if anomalous origin of the right coronary artery from the left coronary sinus can lead to the development of early atherosclerosis. They demonstrated that patients with this anatomy were on the average 10 years younger than other patients, suggesting that early development of coronary artery disease may be associated with this condition. Dr. Ian Duncan and colleagues from the Interventional Unit at Sunninghill Hospital in Sandton, South Africa, relates their experience with coronary artery fistulas that were successfully treated primarily with percutaneous endovascular cyanoacrylate embolization. Although successful, the authors acknowledge that this embolic agent is hazardous and complications can occur, arguing for its use by experienced operators. In the last original research article, Dr. Warren Cantor and colleagues from the Division of Cardiology at St. Michael’s Hospital in Toronto, Canada, Geisinger Medical Center in Danville, Pennsylvania and Duke University in Durham, North Carolina present analyses of data from the ESPRIT trial to determine the timing of ischemic complications within the 30 days following PCI. They found that 85% of complications occurred within the first 12 to 18 hours and 31% of patients who had a subsequent MI within 24 hours had completely normal enzymes at the 6-hour measurement. Five of our special sections are featured in this issue of the journal. In the first special section, Interventions in Peripheral Vascular Disease, edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital /Medstar Health in Baltimore, Maryland, Drs. Morales, Kirvaitis and Heuser from the Phoenix Heart Center at St. Joseph’s Medical Center in Phoenix, Arizona present some of their initial results using a fiberoptic guidance technology to treat chronic superficial femoral artery occlusions. In Clinical Images, edited by Dr. David Rizik from Scottsdale Heart Group in Scottsdale, Arizona, Dr. Emmanouil Brilakis and colleagues from the Mayo Clinic have provided an interesting patient who developed unstable angina due to stent fracture. In the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Dr. Monakier and colleagues have presented a patient with drug refractory hypertrophic obstructive cardiomyopathy who received intracoronary MCE. In the Electrophysiology Corner, edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York, Drs. Jon Block and Abraham Kocheril have provided a paper reviewing the role of right atrial ablation in the management of atrial fibrillation. In the last special journal section, Practice Management, edited by Dr. Ronald Riner of the Riner Group, Dr. Riner and colleagues Keelyn Meisinger and Jere Palazzolo have provided a discussion of improvements and innovations in physician compensation plans, describing how these are implemented in a tiered model. This issue of the journal also includes several interesting case reports. In the first report, Drs. Chacko, Bhatt and Marrouche from the Cleveland Clinic Foundation present a patient who sustained an asymptomatic acute anterior MI from thermal injury complicating radiofrequency ablation for AV nodal re-entrant tachycardia. In the second case report, Drs. Iyisoy, Kursaklioglu and Barcin from the Department of Cardiology at Gulhane Military Medical Academy in Etlik, Ankara, Turkey present a case that demonstrates the value of using intravascular ultrasound to evaluate a situation that appeared to be dissection that was actually thrombus. In the next case report, submitted by Drs. Kim, Choi and Yoo from the Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine in Seoul, Korea, the authors describe their successful management using a combination of bypass graft surgery and PTA in a patient with total occlusion of both subclavian arteries and the descending abdominal aorta. In the next case report, Drs. Alfonso, Alvarez and Almeria from the Interventional Cardiology Unit, Cardiovascular Institute at the San Carlos University in Madrid, Spain demonstrate the value of intravascular ultrasound for the diagnosis and management of iatrogenic acute aortic dissection during coronary angioplasty for in-stent restenosis. In the next case report, Dr. Walther Mashman and colleagues from the Cardiac Disease Specialists and Fuqua Heart Center at Piedmont Hospital in Atlanta, Georgia describe a case in which an internal thoracic artery was placed in a coronary vein and then subsequently attached in a reoperation to the coronary artery, preserving the arterial conduit. Finally, Drs. Hassan and colleagues from King Faisal Specialist Hospital and Research Center, in Riyadh, Saudi Arabia describe a case in which coronary artery compression that occurred during mitral valve replacement was treated using three drug-eluting stents with excellent results. Several of the case reports in this issue provide brief literature reviews. Dr. Zachary George and colleagues from Indiana University and the Krannert Institute of Cardiology in Indianapolis present an unusual case in which a patient post infarction had simultaneous development of a true and false left ventricular aneurysm with concomitant rupture of the false aneurysm into the right atrium. They provide a review of the literature on the pathogenesis of true and false aneurysms and diagnostic approaches to identifying these conditions. Drs. Oyama, Urasawa and Kitabatake from the Hokkaido University Graduate School of Medicine in Sapporo, Japan present a case review on the detection and treatment of coronary artery pseudoaneurysms following coronary stent deployment. In the next case review, Dr. Monika Juszczyk and colleagues from St. Elizabeth Health Center in Youngstown, Ohio report on spontaneous coronary artery dissection postpartum treated with glycoprotein IIb/IIIa inhibitors and stenting. Dr. Jose de la Torre-Hernandez and associates from the Interventional Cardiology Department at the Hospital Marques de Valdecilla in Santander, Spain describe their use of ultrasound to characterize “pseudostenoses” encountered during PCI. In the next case report with review, Dr. Bertrand Tchana and collaborators from the Cattedra di Cardiologia Pediatrica, University di Parma in Parma, Italy and the Mayo Clinic in Rochester, Minnesota, present their experience in treating a patient with an atrial septal aneurysm and multiple associated atrial septal defects that ultimately required surgical intervention for definitive treatment. Drs. Jorge Bejarano and Antonio Muniz describe their use if bivalirudin instead of heparin in a patient with severe thrombocytopenia and provide a succinct review of the literature on this problematic condition. The next case report and literature review also touches on the issue of thrombocytopenia and comes from Drs. Vibhavasu Sharma and Dan Mascarenhas from Easton Hospital in Easton, Pennsylvania. The authors report on a 75-year-old man who received abciximab following PCI and developed thrombocytopenia, which was successfully treated. The last case report and literature review is a description of the use of the Accunet™ Embolic Protection System during mechanical thrombolysis of a thrombosed prosthetic aortic valve and comes from Drs. Shavelle, Salami and Burstein of Good Samaritan Hospital in Los Angeles, California. This issue is completed with three additional special articles. The first is a thorough review by Dr. David D’Agate on the evolving role of glycoprotein IIb/IIIa receptor blockade during PCI of saphenous vein grafts. The second special article is a comprehensive review of the management of coronary artery dissection and perforation by Jason Rogers and John Lasala of the University of California, Davis Medical Center in Sacramento, California and Washington University School of Medicine in St. Louis, Missouri. And finally, we have included a CME offering provided by Dr. Ali Archad and collaborators covering the role for percutaneous thrombectomy in contemporary treatment of Acute MI. It is my hope that all of the articles in this issue of the journal provide healthcare professionals with valuable information that is useful in the daily care of patients with cardiovascular disease.