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.

Transesophageal echocardiographic Doppler study of coronary flow in a patient with myocardial bridging--a case report.

A case report of myocardial bridging of the left anterior descending artery is described. Coronary flow proximal to the myocardial bridge was studied with transesophageal echo Doppler. The patient, a 62-year-old farmer who sustained an anterior myocardial infarction, underwent thrombolysis and was admitted. He subsequently underwent coronary angiography and left ventriculography, which showed a severe myocardial bridge of the midshaft of the left anterior descending artery. The ejection fraction improved from 25 to 48% after thrombolysis, as measured by using echocardiography. Transesophageal Doppler study proximal to the myocardial bridge revealed a relative increase of the diastolic coronary flow velocity (increased acceleration), which reached its peak value in early diastole. Despite the presence of severe myocardial bridging, coronary flow reserve increased substantially two minutes after the infusion of dipyridamole (0.56 mg/kg iv for 4 minutes). Transesophageal Doppler study of coronary blood flow proximal to the myocardial bridge in the left anterior descending artery showed a characteristic waveform that may prove to be indicative of this condition.

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.

Communication between a nongrafted left internal mammary artery and left anterior descending coronary artery following saphenous vein bypass grafting.

A case is described in which a pericardial branch of a nongrafted left internal mammary artery communicated directly with the distal left anterior descending artery, following saphenous vein bypass grafting. This type of collateralization following coronary artery bypass surgery seems to be very rare, and perhaps could protect the myocardium from severe ischemia.

Isolated corrected transposition of great arteries and double left anterior descending artery originating from the left and right coronary artery. A rate combination of coronary artery anomaly and congenital heart disease.

A case of double left anterior descending coronary artery in a patient with isolated corrected transposition of great arteries is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly seems to be very rare.

Effects of a low-dose fish oil concentrate on angina, exercise tolerance time, serum triglycerides, and platelet function.

Fish oils have shown beneficial effects on various parameters in patients with coronary artery disease (CAD). The purpose of this study was to investigate whether the same effects can be demonstrated with a low dose of fish oil concentrate (FOC). Thirty-nine patients were studied and divided into two groups. Twenty were given 10 g fish oil (group A) and 19 were given 10 g placebo Italian olive oil (group B). Weekly anginal attacks (AA), weekly glyceryl trinitrate consumption (GTN), exercise tolerance time (ETT), serum triglycerides (ST), platelet aggregation ratio (PAR), and beta-thromboglobulin were measured at eight and twelve weeks after start of treatment. 1. The number of anginal attacks recorded by both groups decreased by 41% in group A reaching statistical significance (P < 0.05). No change was observed in group B. 2. GTN consumption decreased in group A (P < 0.05) with no significant change in group B (P:ns). 3. ETT increased significantly in group A eight and twelve weeks after start of treatment (20.6% P < 0.01, 22.6% P < 0.01). A smaller but insignificant increase was observed in group B (P: ns). 4. ST decreased significantly in group A by 22% eight weeks after start of treatment (P < 0.01) and to a lesser degree (11%) twelve weeks after start of treatment (P: ns). In group B, ST slightly increased (P: ns). 5. No statistically significant change was observed in either group in regard to PAR and beta-thromboglobulin (P: ns). These observations suggest that dietary supplementation with a low dose of FOC may have beneficial effects on the clinical status of patients with CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary angioplasty in the elderly: immediate and long-term results.

Coronary angioplasty was performed in 37 elderly patients (> sixty-eight years) with unstable or stable angina, refractory to medical treatment. History of myocardial infarction was present in 38% and of previous bypass surgery in 5% of patients. Coronary angiography revealed single-vessel disease in 22 (59%) and multivessel disease in 15 (41%) of patients. The mean left ventricular ejection fraction was 53 +/- 17%. Percutaneous transluminal coronary angioplasty (PTCA) was successful in 92% of patients; there were two angioplasty failures and 1 acute occlusion leading to Q wave myocardial infarction. In patients with multivessel disease complete revascularization was achieved in 33%. Follow-up data (21.29 +/- 9.23 months) are available in all patients with primary angiographic success. There was 1 death. Seventy-nine percent of patients had an improved anginal status, and repeat PTCA was performed in 2 patients because of clinical recurrence. Thus, coronary angioplasty is a safe and efficacious method of revascularization in symptomatic patients over the age of sixty-eight years.

Double left anterior descending artery originating from the left and right coronary artery: a rare coronary artery anomaly.

A case of double left anterior descending coronary artery is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly of coronary arteries seems to be very rare.