Mar-06

Dear Readers, This issue of the Journal of Invasive Cardiology, which coincides with the Annual Scientific Sessions of the American College of Cardiology. Please be sure to visit our website for the informative case reports that are part of the March 2006 issue, as well as more proceedings from the 2004 International Andreas Gruentzig meeting (Industry Round Table: Where Are the New Devices?): www.invasivecardiology.com The first research article, submitted by Eberhard Grube and associates from the Klinikum Siegburg and EMO Centro Cuore Columbus, reports on the safety and efficacy of a new device used for the treatment of chronic total occlusions. They were able to achieve 76% success in chronic total occlusions where conventional guidewires had failed. In the next original article, Biswajit Kar and colleagues from the Texas Heart Institute, describe a series of five patients in whom a TandemHeart percutaneous ventricular assist device was used to support very high-risk patients undergoing PCI. The pVAD device appeared to provide sufficient circulatory support for hemodynamic protection during high-risk PCI. Drs. James Hopkins and William Weintraub from Christiana Care Health Services in Newark, Delaware, offer an excellent commentary to accompany this article. Next, Dr. Salman Ashfaq and collaborators from the University of Kansas and Emory University, report on the impact of diabetes on five-year outcomes in patients after interventions to treat vein graft disease prior to the use of drug-eluting stents or distal protection devices. They showed that diabetic patients undergoing vein graft PCI had worse five-year outcomes. Dr. Scott Gall et al. from the Freeman Hospital in Newcastle-upon-Tyne, U.K., present their study on the effects of a rapid ambulation protocol in patients undergoing coronary angiography via femoral access. They demonstrated mobilization within 90 minutes to be feasible and safe for patients undergoing this protocol. Drs. Adnan Chhattriwalla and Deepak Bhatt from the Cleveland Clinic, have provided a commentary to elaborate on this study and suggest areas for future research. The next original contribution is from Drs. Suzuki, Ikeno and Yeung from Stanford University. They present an intricate study comparing the stent strut distribution between Cypher and Taxus drug-eluting stents using optical coherence tomography in a phantom model. Their results suggest that the Cypher stent maintained a more regular strut distribution in a variety of anatomical situations, which should lead to more regular and predictable drug delivery. Dr. Robert Kelly and associates present their study on the influence of body mass index (BMI) on outcomes and the benefit of antiplatelet therapy after nonurgent PCI. Their study showed that increasing BMI was associated with greater efficacy and bleeding outcomes at one year. Furthermore, randomization to early and long-term clopidogrel was associated with even greater improvements in patients with increasing BMI. Next, Drs. Kiran Venkatesh and Tift Mann from the Wake Heart Center in Raleigh, North Carolina, present their study evaluating the combined use of unfractionated heparin and bivalirudin during ad hoc transradial interventions. They found no complications associated with this therapy in this small pilot study. Dr. Avichai Eres from Kentucky Cardiology, describes an analysis of the potential use of bivalirudin as the foundation anticoagulant in PCI. Bivalirudin proved to be an effective anticoagulant in these high-risk patients, with a low rate of bleeding and ischemic events, suggesting that it is safe in this population. The final original research manuscript was submitted by Dr. Koji Kato and colleagues from the Nippon Medical School. They describe their study to assess the utility of using Angio-Seal to achieve access site closure following the removal of an intra-aortic balloon pump. Hemostasis was achieved rapidly and there were no major or minor complications during seven days of monitoring. In the Clinical Images section, edited by Dr. David Rizik from the Scottsdale Heart Group, Dr. Rolf Vogel presents a series of images portraying the course of an unusual case. Dr. Gianluca Rigatelli, from the Rovigo General Hospital, and Dr. Ziyad Hijazi from the University of Chicago, provide a review on the indications and future applications of intra-cardiac echocardiography in cardiac interventions. They analyze two types of equipment available and provide guidance on evaluating the usefulness of each in clinical situations. In our Clinical Report and Review article, Dr. John Liuzzo and colleagues from Columbia University Medical Center, demonstrate the complications that can occur from acute myocardial infarction and the importance of intra-aortic balloon pumping as a bridge therapy to recovery. This issue of the Journal also includes case reports that are published online. Drs. Piña, Exaire and Sandoval from the Instituto Nacional de Cardiologia in Mexico City, provide a case demonstrating their management of a patient with left main coronary artery extrinsic compression syndrome using IVUS and a pressure wire. In the next case report, Drs. Nakamura, Shiba and Wada from Tokyo, describe their technique for deploying a stent in a highly angulated position through the use of a stent strut. Drs. Kawamura, Tilem and Gossman from the Lahey Clinic in Burlington, Massachusetts, report on their use of rheolytic thrombectomy for thromboembolic occlusion of the carotid artery complicating coronary intervention. In the next case report, Dr. Pierre Aubry and colleagues from the Groupe Hospitalier Bichat-Claude Bernard in Paris, describe their management using early systemic device embolization after transcatheter PFO closure. Drs. Satran, Dawn and Leesar from the University of Louisville, describe a case in which a young woman presented with congenital ostial left main coronary artery stenosis associated with a bicuspid aortic valve. Dr. Stefania Luceri and associates from the Ospedale Mauriziano Umberto I in Turin, Italy, report an unusual case in which a woman experienced spontaneous dissection of the left coronary tree after an interruption of a pregnancy that was successfully treated with extensive use of stenting. In the last case report, Drs. Peirone, Spillmann and Pedra describe their successful treatment using occlusion of multiple pulmonary arteriovenous fistulas using Amplatzer vascular It is my hope that these articles provide important information that will assist cardiovascular healthcare professionals in the effective management of their cardiac patients. Sincerely, Richard E. Shaw, PhD, FACC, FACA Editor-in-Chief