Current interventional cardiology reports最新文献

This article reviews the most recent results of the latest modification of the buttoned device (Custom Medical Devices, Amarillo, TX), the 4th generation. The latest advances in atrial septal defect (ASD) occlusion with further modifications of the buttoned device--inverted buttoned device, hybrid buttoned device, and centering- on-demand device (COD) (Custom Medical Devices)--that have led to the evolution of wireless and deviceless ASD occlusion are also presented.

Proximal subclavian or brachiocephalic artery obstruction may present with a variety of symptoms. Surgery has been considered by many to be the corrective procedure of choice, but percutaneous alternatives are becoming increasingly popular. Little work has been done to compare the outcomes of the two techniques. Presenting symptoms in this condition often include angina secondary to coronary-subclavian steal, subclavian steal syndrome, arm ischemia, and axillo-femoral graft inflow obstruction. A systematic review of the surgical literature has been performed and has included analysis of the incidence of technical success, overall complications, stroke, death, and subsequent patency. However, despite comparison of these data to the published series of stenting, there are no head-to-head trials of one technique versus another. Review and analysis of the contemporary literature suggests a high patency and low complications in stent series, and is in contrast to similar midterm patency but a higher incidence of stroke and death in the surgical literature. A variety of techniques can be used for successful stent-based revascularization, and a blending of skills from the traditional "coronary" and "peripheral" venues may be helpful. Comparison with the published surgical experience suggests that the effectiveness of percutaneous revascularization is at least equivalent and that these techniques may be associated with fewer procedure-related serious complications. Percutaneous stenting should be considered a first-line therapy in treating subclavian or brachiocephalic obstruction.

Evidence from randomized trials supports the administration of platelet glycoprotein (GP) IIb/IIIa blockade both to patients undergoing percutaneous coronary intervention (PCI) and those presenting with non-ST elevation acute coronary syndromes (ACSs). Similarly, the low molecular weight heparin (LMWH), enoxaparin, has demonstrated superior efficacy when compared with unfractionated heparin (UFH) in the treatment of patients with non-ST elevation ACS. Algorithms for seamless integration of pharmacotherpy through the course of hospitalization for patients who present with ACS and who require PCI will likely combine therapy with enoxaparin and platelet GP IIb/IIIa blockade (abciximab). Our preliminary experience with combination enoxaparin and abciximab as adjunctive pharmacotherapy for PCI suggests that this strategy is safe and effective and may offer advantages over a conventional strategy, which employs UFH.

The atrial septal defect occluder system (ASDOS) (Osypka Corp., Grenzach-Wyhlen, Germany) has been used clinically for transcatheter closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO) after episodes of cerebral embolism over the last 10 years. In this article, the up-to-date experience with this system is reviewed.

Percutaneous management of hemodialysis grafts has become the standard of choice for treating failing or failed shunts. This article addresses the early diagnosis of compromised grafts and the treatment options in managing diseased grafts, including newer technologies. Despite good techniques in being able to reopen occluded grafts, the long-term results are still poor.

Acute limb ischemia is a result of decreased arterial perfusion resulting in inadequate tissue perfusion. The severity of symptoms and urgency for treatment depends on the status of the collateral circulation. Therapy should be directed toward both systemic and local factors. Treatment is by open surgery, thrombolysis, or percutaneous thrombectomy. Unfortunately, none of the treatment modalities have proven to be the golden standard for limb salvage and patient survival. Review of current literature and a multimodality approach for the management of acute limb ischemia is presented in this article.

More than a century ago, Pratt demonstrated that perfusion of arterial blood through the coronary veins could sustain myocardial viability during acute ischemia. Recognition that atherosclerosis spared the coronary veins and that these vessels frequently followed a parallel course to the corresponding artery provided the necessary stimulus for the development and evaluation of several methods of venous retroperfusion. Although most of these procedures have now been superseded, the coronary veins remain a tempting therapeutic target when direct arterial revascularization is not feasible. Novel percutaneous strategies using these vessels to provide definitive myocardial revascularization have been proposed and extensively tested in animals.

The development of a suitable arterial substitute that would be durable in the long term has been a cherished goal of vascular surgeons and physicians for decades. Over this time period various conduits have been tried with varying degrees of success, but today we continue to use the autogenous veins and arteries that were proven successful for bypass grafting over 20 years ago. Despite the arrival of tissue engineering the ultimate prize of a totally artificial artery still eludes us, but a number of recent developments in this exciting field suggests that this goal may not be as distant as previously thought.

The Amplatzer septal occluder (AGA Medical Corporation, Golden Valley, MN) is designed to be an ideal device for the transcatheter closure of ostium secundum atrial septal defects. This device is user-friendly and has a complete closure rate of greater than 96% and few complications. It is easily retrievable and repositionable. It is also useful for closure of other types of shunts. Large atrial septal defects (ASDs) of up to 38 mm may now be closed. The use of the transesophageal echocardiogram (TEE) for evaluation of device placement is also reviewed.

Retrograde coronary venous perfusion can preserve myocardium during experimental coronary artery occlusion and has been used clinically to deliver oxygenated blood to ischemic myocardium during unstable angina or high-risk percutaneous transluminal coronary angioplasty (PTCA). Retrograde delivery of drugs accelerates coronary thrombolysis, preserves regional myocardial function, and limits infarct size in animal models. Modifications of the coronary venous retroperfusion technique have allowed access to smaller coronary venous branches and minimization of systemic effects of local drug delivery. Retrograde coronary sinus perfusion as an adjunct in high-risk coronary PTCA is limited by its inability to provide systemic hemodynamic support during circulatory collapse. Targeted and specific gene delivery to myocardium with transfection rates superior to intraarterial or systemic injection may be a promising new application for this technique. The coronary venous system can also be used for the noninvasive creation of coronary artery bypasses or the insertion of leads for left ventricular pacing. Contrast-enhanced electron beam computed tomography (EBCT) can noninvasively provide high-resolution imaging of the coronary vessels with qualitative and quantitative information on coronary venous anatomy and coronary arteriovenous relationships and may help in selecting appropriate candidates, anticipating the degree of difficulty of the procedure, and guiding the approach. Therefore, EBCT may become the imaging modality of choice for the assessment of patients considered for such strategies.