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Successful treatment of superficial femoral artery (SFA) and below-the knee (BTK) chronic total occlusions (CTO) involves selection of an optimal crossing strategy (‘wire-catheter’ vs. dedicated CTO crossing device). We analyzed data from the multi-center XL PAD registry between July 2005 and

This study was designed to assess the contribution of clinical, electrocardiographic and exercise hemodynamic variables to the prediction of normalization on resting reinjection scintigraphy of persistent thallium-201 (201Tl) myocardial perfusion defects seen with exercise and 2- to 4-hour delayed (redistribution) imaging. To evaluate this contribution, we studied 159 consecutive patients with persistent 201Tl myocardial perfusion defects on routine exercise and 2- to 4-hour-delayed scintigrams at the University of Rochester Medical Center who were classified as having moderate or greater ischemic normalization (group 1, n = 76) or minimal to no ischemic normalization (group 2, n = 83) by reinjection scintigraphy. Multiple logistic regression analysis with backward elimination was used to model the effects of clinical, electrocardiographic and exercise hemodynamic data on the odds ratio of a normalized defect. No difference was observed in the two groups with regard to gender, angina on exertion, rate-pressure product, exercise duration, resting or exertional ischemic ST changes on electrocardiogram, presence of Q waves or left ventricular hypertrophy on baseline electrocardiogram, or total number of stress thallium defects (2.8 +/- 1.5 segments). No single variable or combination of variables discriminated between groups 1 and 2 by logistic regression analysis. We conclude that defect normalization seen on resting 201Tl myocardial perfusion scintigraphy is prevalent in patients with persistent defects on routine exercise and delayed myocardial perfusion scintigraphy, and was not predictable from available clinical, electrocardiographic and exercise hemodynamic variables.

In this study we compare the outcomes of the paclitaxel-eluting stent (PES) versus the everolimus-eluting stent (EES) treated patients at a tertiary medical center and up to two years follow up. Unselected consecutive patients were retrospectively recruited following stenting with PES (159 patients

consecutive patients who underwent EVLT for short saphenous varicose veins in our department. A total of 59 consecutive procedures were performed in 52 patients during the study period. Patient age ranged from 21 to 86 (mean 51) years. All procedures were performed under local anaesthesia. Vein lengths treated ranged from 4 to 35 (mean 19) cm. The median amount energy utilized for venous ablation was 74 (range 60–88) J/cm. Results: No complications were encountered in any patients, apart from a single patient suffering from a wound infection. Follow up periods ranged from 2 to 24 months. A single recurrence was detected on clinical examination and duplex evaluation. Conclusion: EVLT is not only an effective option for SSV but has a very good safety profile. Recurrence rates are minimal and our interim results support this.

Results: Mean age was 63±7.3 years, 95% were men and 100% were diabetic. Mean lesion length was 156.9±94.7 mm; 43.5% were total occlusions. Mean presenting Rutherford category was 3.0±0.3. A total of 20 limbs (43.5%) were debulked using laser atherectomy, rotational atherectomy, directional atherectomy and/or cutting balloons. Immediate postprocedural mean PVR was significantly lower in the debulking group compared to the conventional balloon predilation group (0.96 vs. 1.07, P=.01). Furthermore, mean ABI was significantly lower in patients who had PVR ≥2 compared with patients who PVR ≤2 at 6 months and 1 year postprocedure (0.64 vs. 0.89, P=.005; 0.42 vs. 0.70, P=.01, respectively). Mean NDEMD was lower in the debulking group; however, the difference was not statistically significant. Conclusion: Our results suggest the potential utility of debulking prior to the deployment of n-SES in complex SFA lesions in diabetics.

The properties and physiological effects of three currently FDA-approved thrombolytic agents, streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasmminogen activator complex (APSAC) are reviewed. All thrombolytic agents have been shown to reduce mortality postmyocardial infarction (MI). Comparative trials have failed to demonstrate a difference between the effects of tPA, SK, and APSAC on mortality. In addition, no consistent difference between the three agents on ejection fraction (EF) has been found despite a superior reperfusion rate with tPA at 90 min. Further-more, reinfarction and interventional procedure rates were significantly higher after thrombolytic treatment, and the incidence of total strokes was higher with tPA than SK in some comparative studies. Based on analysis of the published megatrials, SK is a more cost-effective thrombolytic agent for patients with acute MI than tPA or APSAC.

Endocarditis caused by Fusobacterium nucleatum is exceedingly rare. We report a case of F. nucleatum right-sided endocarditis in a patient with no known intravenous drug abuse. A detailed computer and manual search of the literature using Med-Line and Index Medicus, respectively, revealed a total of five cases of endocarditis due to this species. The clinical characteristics and the patient's hospital course are summarized and reviewed.

Summary Background: The effect of withdrawal of digoxin on left ventricular function in patients with a history of idiopathic dilated cardiomyopathy (IDCM) following normalization of left ventricular ejection fraction (LVEF) with beta blockers remains unknown. Hypothesis: This study was undertaken to determine the effect of digoxin withdrawal on left ventricular function in patients with IDCM. Methods: In 8 consecutive patients with IDCM (5 men, 3 women) who had normalization of LVEF following betablocker treatment, digoxin was withdrawn as part of an office protocol, and LVEF was followed. Baseline EF prior to beta blocker initiation (carvedilol = 6, atenolol = 1, metoprolol = 1) was measured with isotope ventriculography (IVG), echocardiography, or left ventriculography. Post beta blocker ejection fraction (post BB EF) was measured in all patients with IVG at a mean of 17.25 ± 5.38 months. Follow-up EF was measured using IVG after digoxin withdrawal at a mean of 6.99 ± 4.34 months. Results: An experienced blinded reader interpreted the IVG scans. Baseline EF was 28.5 ± 8.26; postBB EF and follow-up EF were 56.1 ± 4.65 and 51.0 ± 7.35, respectively (p = 0.05). Conclusion: These data provide potential evidence that digoxin withdrawal can result in a small but significant reduction in LVEF in patients with IDCM who had normalization of LVEF after treatment with beta blockers. Mean LVEF, however, remained within normal (> 50%) on beta-blocker therapy and without digitalis. Large, randomized controlled trials are needed to confirm these findings.

Background: Multiple strategies have been proposed to treat bifurcating coronary artery disease including both main branch (MB) stenting and side branch (SB) stenting (MBSB) or 1-branch stenting with provisional stenting of the other branch (PSOB). We present our own experience with MBSB stenting vs PSOB using the Taxus (Boston Scientific, Natick, MA) paclitaxel drug-eluting stent (Boston Scientific). The study was approved by the institutional review board at our center. Methods: Five hundred eighteen consecutive patients with de novo lesions underwent bifurcating stenting in 2005 at our institution using the Taxus stent (86 PSOB, 432 MBSB). Follow-up data on 312 (60.2%) patients was achieved using phone interviews and review of medical records (52 PSOB, 260 MBSB). Mean follow-up was 6.7 months. Plavix and aspirin were ordered for at least 6 months post procedure. The primary end point of the study was the combined end points of cardiac death, nonfatal myocardial infarction (ST-elevation MI and non–ST-elevation MI) and target lesion revascularization. Secondary outcomes included the individual end points of death, cardiac death, AST, TVR, target lesion revascularization, ST-elevation MI, and non–ST-elevation MI. Results: Demographic, clinical, and angiographic variables were not statistically different between the 2 groups. Procedural success (b30% residual) was 98% and 94% in the MB and SB in the MBSB group and 100% and 94.4% in the MB or SB, respectively, in the PSOB group. Kissing balloon was performed in 76% of lesions treated. Intermediate-term outcomes between MBSB and PSOB were statistically similar with a trend toward a better overall combined primary end point in the PSOB group compared to the MBSB one (10.8% vs 5.8% respectively). Conclusion: A strategy of PSOB provides similar intermediate-term outcomes to MBSB stenting and needs to be considered as a first approach to treating bifurcating disease.

Purpose: To report the results from a single-center prospective registry (PROTECT)established to evaluate the safety and effectiveness of embolic filter protection (EFP) inreducing distal embolization during percutaneous lower extremity interventions.Methods: Patients undergoing angioplasty, stenting, or SilverHawk atherectomy andadjunctive balloon angioplasty for infrainguinal occlusive disease were eligible if thelesion(s) met one or more of these angiographic criteria: (1) moderate or severecalcification of any length, (2) total occlusions of any length, (3) a filling defect, (4)irregular (ulcerated) lesions at least 30 mm in length, and/or (5) smooth, non-ulceratedlesions at least 50 mm in length. The primary angiographic outcome was the ability of thefilter to prevent angiographically visible distal embolization, slow flow, and loss of distaltibial runoff with or without capturing macrodebris.Results: Forty patients (23 men; mean age 71.4611.5 years) with 56 lesions (42 de novoand 14 restenotic) underwent treatment with angioplasty/stenting (groupA,n529; 43lesions) or SilverHawk atherectomy (group B, n511; 13 lesions). One filter was used perpatient (25 SpiderFX and 15 EmboShield). Macroembolization occurred in 22 (55.0%)patients, 11 (37.9%) in group A and 11 (100%) in group B (p,0.001). Clinically significant($2 mm in diameter) macrodebris was found in 18 (45.0%) patients: 8 (27.6%) in group Aand 10 (90.9%) in group B (p,0.001). All filters were retrieved successfully with nocomplications. One side-branch embolization occurred proximal to the filter. In anothercase, the filter was overfilled, resulting in no distal flow; it was retrieved, with subsequenttibial embolization when the procedure was continued without protection.Conclusion: Macroembolization is very frequent in patients undergoing lower extremityinterventions, particularly with SilverHawk atherectomy. EFP appears to be very effective incapturing macrodebris, and its use is associated with good acute angiographic outcome.The clinical significance of these findings needs to be determined in future studies.J Endovasc Ther 2008;15:270–276Key words: peripheral angioplasty, embolization, embolic filter protection, atherectomy,stent

Coronary flow reserve (CFR) measurements are useful for assessment of coronary stenoses and microvascular function in patients. Intracoronary Doppler probes are commonly used for CFR measurement, but changes in flow velocity reflect volumetric flow only if the conduit vessel size is constant. We hypothesized that potent resistance vessel dilators used for CFR measurement also produce conduit artery dilation that perturbs the relationship between coronary flow velocity and volumetric flow. Methods Coronary flow velocimetry (Doppler-tipped guidewire) and quantitative angiography were performed in a non-stenotic artery at control (Con), and during a maximally dilating dose of intracoronary adenosine before and after nitroglycerin (NTG) 100 μg i.c. in 6 patients. CFR was measured conventionally using peak/rest flow velocity changes alone (Vel) and flow estimates incorporating angiographic vessel cross-sectional area (VxA). Results (mean ± s.e.m.) Coronary Diameter (mm) CFR Con adenosine NTG Con Vel Can VxA NTG Vel 2.50 ± 0.26 2.89 ± 0.30 * 2.93 ± 0.28 * 3.0 ± 0.2 4.0 ± 0.3 † 3.8 ± 0.4 ‡ * p l 0.01 vs control † p l 0.01 vs can Vel ‡ p = 0.08 vs can Vel Conclusions 1) Intracoronary adenosine produces concurrent conduit as well as resistance vessel dilation that is similar in magnitude to nitroglycerin. 2) Coronary flow reserve is underestimated if blood flow changes are assessed using flow velocity measurements alone. 3) Coronary flow reserve measured using velocity changes after pretreatment with nitroglycerin is similar to measurement that incorporates angiographic cross-sectional area, and may obviate the need for area determination.

1. 1. Dopamine binding to amacrine membrane vesicles isolated as synaptosomal fractions P 1 and P 2 from rabbit retinas showed saturation within less than a minute. 2. 2. Dopamine binding to retinal synaptosomal membranes (RSM) in P 1 and P 2 is a two-component system: the first saturated at 1.00 μM 14 C-dopamine in P 1 and 1.25 μM in P 2 , and the second saturated at 2.00 μM in both pellets. 3. 3. The affinity of RSM receptors to dopamine in P 1 was equal to that in P 2 ( K m = 2.00 μ M), whereas the calculated V max of dopamine binding was increased in P 2 (1.25 pmol/μg protein) as compared to P 1 (0.625 pmol/μg protein). 4. 4. Dopamine binding to the β-adrenergic sites showed a lower affinity ( K m = 10 μ M) in P 2 relative to P 1 ( K m = 4.0 μ M), whereas V max in P 2 (5.0 pmol/μg protein) was 4-fold higher than P 1 (1.25 pmol/μg protein). 5. 5. The P 1 and P 2 fractions of rabbit RSM contain dopaminergic and β-adrenergic binding sites with higher concentration of dopaminergic receptors and lower concentration of β-adrenergic receptors in P 2 relative to P 1 .

1. Dopamine (DA) binding sites in the left and right ventricle of hypertensive rats were assessed after two weeks of induction of hypertension by left renal artery occlusion. 2. The ratio of left ventricular (LV) weight to total body weight was significantly increased in hypertensive rats from 2.046 +/- 0.120 mg g-1 to 3.125 +/- 0.090 mg g-1 (P less than 0.01) while no significant difference was noted in the right ventricle (RV). 3. The hypertrophied LV was associated with a 78% increase in its protein content, however, the ratio of protein content to ventricular wet weight was not significantly different from controls. No change in RV protein content and concentration was observed. 4. Dopamine affinity of sarcolemmal protein was not significantly different in control and experimental LV and RV and the ratio of DA affinity in LV:RV was 10:1. 5. Saturation of LV with DA was reached at around 7 min whereas RV was saturated at approximately 15 min.

The objective of these experiments was to investigate the direct effect of prostacyclin on calcium binding and uptake by microsomal vesicles isolated from rat left ventricle. The protein content of the preparation was found to be 2.73 +/- 0.18 mg microsomal protein/g of left ventricular wet weight. Steady-state calcium binding and uptake by microsomal vesicles was reached at 6 minutes in control animals and 20 sec in prostacyclin-treated experiments. Prostacyclin increased steady-state calcium binding and uptake from a control of 52.48 +/- 4.16 up to 109.31 +/- 3.06 nmol/mg protein (p less than 0.05) and from 238.07 +/- 12.37 up to 314.85 +/- 1.23 nmol/mg protein (p less than 0.05) respectively. Doubling the concentration of prostacyclin from initial dose of 1.2 x 10(-8) M did not alter calcium binding and uptake further.

Treatment of in-stent restenosis of the femoropopliteal artery is challenging with a high rate of restenosis. Excimer laser atherectomy (ELA) has a theoretical advantage of ablating restenotic tissue and reducing or delaying the need for repeat revascularization. We present a retrospective analysis

Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor + aspirin (ASA) decreases drug-eluting stent (DES) thrombosis. Annually 5%-10% of DES patients (pts) are advised DAPT interruption to reduce peri-operative (peri-op) bleeding. Premature DAPT stoppage especially early during the first year

The JetStream Navitus (JS) (Boston Scientific) is an atherectomy device that uses rotational cutting and aspiration to treat infringuinal arterial obstructive disease. The number of blades up (BU) runs needed to achieve safe and maximum tissue debulking using the JS is unknown. In this swine model

There are limited data regarding frequency of use and outcomes of the only approved drug coated stent (DCS; Zilver PTX®; Cook) during endovascular revascularization of infrainguinal arteries. We compared DCS to bare metal stent (BMS) use in procedures performed from January 2013 - August 2014