Management of radial artery perforation during coronary angiography and angioplasty--a report of two cases.

Perforation and disruption of the artery used for access is a recognized complication of coronary angiography. There is an increasing trend toward use of the radial artery for angiography and angioplasty, particularly in the primary angioplasty setting, because of the reduced risk of hemorrhagic complications. On the rare occasions when radial artery perforation occurs, operators have had a tendency to switch to a second arterial access route. This article describes a technique for managing peri-procedural perforation which does not require use of a second artery for access. We show two cases where this technique was used successfully, demonstrating an angiographically normal radial artery at the end of the procedure.

Drug-eluting Stents in Acute Coronary Syndrome: Is There a Risk of Stent Thrombosis with Second-Generation Stents?

Over the past decade, the advent of drug-eluting stents (DES) has revolutionised the field of interventional cardiology by having a major impact on patient care through their efficacy in reducing the need for repeat revascularisation. A number of stents capable of delivering an anti-proliferative agent designed to prevent neointimal hyperplasia, the principal mechanism of restenosis after stenting, have been evaluated; four of these devices are currently approved by the U.S. Food and Drug Administration (FDA). Bare metal stent (BMS) and first-generation DES, such as sirolimus-eluting (SES-Cypher(®)) and paclitaxel-eluting stents (PES-Taxus(®)), have further improved results of percutaneous coronary intervention (PCI) by improving early results and reducing the risk of restenosis. However, there is currently debate on the safety of these first-generation DES, given the potential for late stent thrombosis (LST), especially after discontinuation of dual anti-platelet therapy. Second-generation DES, such as zotarolimus-eluting (ZES-Endeavor(®)) and everolimus-eluting stents (EES-Xience V(®)), are become available in the USA and/or Europe. Recently, long-term results comparing DES with BMS in patients with ST-segment-elevation MI (STEMI) have raised some questions about the long-term risks of the drug-eluting devices. It may be useful to pause, reflect for a moment, and consider some recent pertinent results regarding their wider use. This systematic review tries to provide a concise and critical appraisal of the data available to compare first and second generation stents especially to assess risk of stent thrombosis (ST) with second-generation DES.

Keep an eye on the lung.

The case of a 42-year-old man, originally seen in the Ophthalmology clinic after his wife noticed his pupil sizes were different, is presented. He had been feeling tired with lack of energy for 6 months, during which time he had lost about 6.4 kg in weight. Then he started to have night sweats and a non-productive cough. His appetite was good. A chest x ray showed right midzone and some left lung opacities. Thoracic high-resolution CT showed patchy consolidation involving both midzones with widespread nodular shadowing. Transbronchial biopsies showed non-caseating epitheloid cell granulomata consistent with sarcoidosis.