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Intravascular brachytherapy (IVBT) is a useful treatment modality for the recurrence of in-stent restenosis following drug-eluting stents (DES) or IVBT failure. The objective of this study was to measure the dose rate of 90 Sr/ 90 Y IVBT sources for comparison with that given by the manufacturer and to control the dose uniformities of these sources along the source axis. The dose rates of 90 Sr/ 90 Y beta sources were measured with a radiochromic film in a custom-made phantom. The films for calibration were irradiated using 60 Co photon beams. The results for the three sources were 4.5%, 2.3%, and 3.5% higher than the corresponding certificate values. Maximum and minimum of the dose rates varied within ±10% of those at source center; and maximum dose discrepancy for the first 90 Sr/ 90 Y source train was 8.2%; for the second source train, 7.1%; and for the third source train, 5.1%. Our study showed that the dose rates given by the manufacturer for the three 90 Sr/ 90 Y IVBT sources were reliable and dose uniformities were within ±10% along two thirds of the treatment length.

Objective: To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and paclitaxel-eluting stent (PES) in patients with small coronary artery disease., Background: Patients with a small vessel diameter are independently associated with increased risk of adverse cardiac events after drug-eluting stent implantation., Methods: A cohort of 265 patients treated with R-ZES (185 patients with 211 lesions) or PES (80 patients with 100 lesions) in small vessel (≤2.5 mm) lesions were retrospectively analyzed. The primary end point of the study was the composite of major adverse cardiac events. The secondary end points included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis at 3 years., Results: The baseline characteristics were similar between the 2 groups. In the R-ZES group, the mean stent diameter was smaller and the total stent length per lesion was longer. Major adverse cardiac events occurred in 8 (10%) patients who had received PES and in 7 (3.8%) patients who had received R-ZES (P = .07). The rates of 3-year TLR (2.2% vs 2.5%; P = 1.00) and TVR (5.4% vs 10.0%; P = .17) showed no statistically significant difference between the R-ZES and PES groups. The rate of stent thrombosis was 0.5% in the R-ZES group and 2.5% in the PES group (P = .21)., Conclusion: The rates of major adverse cardiac events and cardiac death were similar in the R-ZES-treated group compared with the PES-treated group., (© The Author(s) 2015.)

Objective: Heart rate turbulence (HRT) indicates the impairment of cardiac autonomic function. With the literature containing insufficient information on HRT in stable coronary artery disease (CAD), this study aimed to investigate the role of HRT in patients with stable CAD., Methods: The study included 58 patients (mean age: 58.9 ± 10.0 years; 25 male) with documented CAD and demonstrating ventricular premature complexes on Holter monitoring, and a control group of 52 patients (mean age: 55.9 ± 9.3 years; 36 male) with no history of CAD and demonstrating ventricular premature complexes. HRT parameters such as turbulence onset (TO) and slope (TS) were analyzed. Angiographic Gensini score were used to evaluate CAD severity., Results: There was a significant difference in HRT parameters between the 2 groups. TO: 0.47 ± 1.52% vs. -1.61 ± 2.0% (p=0.001) and TS: 4.7 ± 3.0 vs. 6.4 ± 3.7 ms/RR (p=0.009) in patients with CAD and control group respectively. Given also that TO ≥ 0% and TS ≤ 2.5 ms/ RR values are considered abnormal, there was significant difference between the two groups; TO abnormal: 27 patients (46.6%) vs. 7 patients (13.5%), p=0.001, and TS abnormal: 15 patients (25.9%) vs. 4 patients (7.7%), (p=0.004) in CAD patients and control group respectively. A positive correlation was detected between TO and Gensini score (r=0.282, p=0.001) and a negative correlation detected between TS and Gensini score (r=-0.287, p=0.001)., Conclusion: The study demonstrated that HRT variables are impaired in patients with stable CAD when compared to those in the control group, and that these variables also correlate with severity of CAD.

Objectives: Risk stratification in acute coronary syndromes is an important diagnostic tool guiding future therapy. We evaluated the correlation between the AHCPR (Agency for Health Care Policy and Research) risk classification and angiographic morphology in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS)., Study Design: A total of 163 patients hospitalized with the diagnosis of NSTE-ACS were prospectively enrolled. All the patients underwent AHCPR risk analysis followed by coronary angiography. Based on the AHCPR system, the patients were classified as low (n=25, mean age 55±10 years), intermediate (n=55, mean age 58±10 years), and high (n=83, mean age 61±11 years) risk groups., Results: The three groups were similar with regard to gender, age, and coronary heart disease risk factors (p>0.05). Comparison of the high-risk group with intermediate+low-risk group with regard to lesion morphology showed significantly higher rates of complex lesions (31.9% vs. 4.0%, p=0.001), total occlusion (23.2% vs. 0%, p=0.001), and intracoronary thrombosis (13% vs. 2%, p=0.02) in the high-risk group. In univariate analysis, high risk was significantly associated with the presence of complex lesion, total occlusion, intracoronary thrombosis, and TIMI flow

Retained cardiac pellets are clinically silent foreign bodies that do not cause any cardiovascular disturbance. A 71-year-old woman presented with exertional chest pain. Her physical examination and surface electrocardiogram were normal. After a positive treadmill test, coronary angiography was performed which showed nonsignificant coronary lesions. During fluoroscopy, several pellets were observed throughout the neck and two of them were simultaneously moving within the heart shadow. Transthoracic and transesophageal echocardiography showed no evidence for pericardial effusion. Computed tomography scans of the chest showed the pellets above the left diaphragm in the pericardial area. Her past medical history revealed an accidental shot from a pellet rifle by her son 25 years before, at which time no surgical intervention was planned as she had been asymptomatic.

In this report, we present a 22-year-old female patient referred to our institution for evaluation of anginal chest pain. Her medical history revealed two ablation procedures of the left ventricular outflow tract tachycardia performed 1 month a part, 2 years ago. Coronary angiography revealed chronic total occlusion of the proximal left circumflex artery. To our knowledge, this is the first report of ablation-related chronic total occlusion of a coronary artery.

Intravascular brachytherapy (IVBT) is a useful treatment modality for the recurrence of in-stent restenosis following drug-eluting stents (DES) or IVBT failure. The objective of this study was to measure the dose rate of (90)Sr/(90)Y IVBT sources for comparison with that given by the manufacturer and to control the dose uniformities of these sources along the source axis. The dose rates of (90)Sr/(90)Y beta sources were measured with a radiochromic film in a custom-made phantom. The films for calibration were irradiated using (60)Co photon beams. The results for the three sources were 4.5%, 2.3%, and 3.5% higher than the corresponding certificate values. Maximum and minimum of the dose rates varied within +/-10% of those at source center; and maximum dose discrepancy for the first (90)Sr/(90)Y source train was 8.2%; for the second source train, 7.1%; and for the third source train, 5.1%. Our study showed that the dose rates given by the manufacturer for the three (90)Sr/(90)Y IVBT sources were reliable and dose uniformities were within +/-10% along two thirds of the treatment length.

Bidirectional flow in patients with normal coronary arteries is an indicator of intercoronary continuity, a rare variant of coronary circulation, distinct from collaterals. The case of an 18 year old Turkish male with bicuspid aorta and intercoronary artery is reported and different aspects of this interesting entity are emphasized.

In peripheral arterial obstructive disease, more than 50% of all lesions are localized in the femoropopliteal segment and surgical revascularization is the treatment of choice. Percutaneous transluminal angioplasty (PTA) is recommended for short lesions, with subsequent stent implantation if the result is sub-optimal or dissections occur after PTA or for restenosis. There are both acute and late complications with stent implantation. In the present patient, stents were placed in the left popliteal artery where the left knee joint flexes, and obstruction because of stent fracture occurred 6 months later. The patient eventually underwent left femoro-popliteal saphenous vein bypass grafting.

Objective: The aims of the present study are to evaluate clinical, angiographic, and procedural determinants of creatine kinase (CK) elevation following successful coronary stent implantation, and to assess the relationship between postprocedural CK release and subsequent target vessel revascularization., Methods: Study population was composed of 400 consecutive patients who underwent successful coronary stent implantation. Forty-six patients (11.5%) had CK enzyme levels >2 times the upper limit of normal. This group was compared to 100 patients with no CK release after stenting., Results: Baseline, angiographic and procedural characteristics did not differ between patients with and without postprocedural CK elevation. The significant predictors of CK elevation by multiple logistic regression analysis are unstable angina (p<0.001, OR=5.62 with 95% CI of 2.35-13.45), multiple stenting (p=0.04, OR=2.55 with 95% CI of1.02-6.40) and side branch occlusion (p=0.03,OR=12.20 with 95% CI of 1.22-121.71). By multivariate analysis, postprocedural CK release was found to be a significant determinant of subsequent target vessel revascularization (p=0.032,OR=3.84 with 95% CI of 1.12-13.18)., Conclusion: Our results indicate that side branch occlusion, implantation of > 1 stents per lesion and coronary stenting in unstable angina pectoris are strong predictors of postprocedural CK release. There is a significant relationship between postprocedural CK elevation and subsequent target vessel revascularization.

The aim of the present study was to assess the procedural safety and in-hospital and long-term effectiveness of heparin-coated Jostents after failed thrombolysis in acute myocardial infarction. We prospectively analyzed the acute and long-term clinical and angiographic outcomes of 35 consecutive patients treated with heparin-coated Jostents for thrombolytic failure. Rescue coronary stenting was successful in 34 of 35 patients (97%). Thrombolysis in Myocardial Infarction flow grade 3 was obtained in 31 patients (88.5%). The only patient with procedural failure died from cardiogenic shock a day after the procedure. One patient (2.8%) underwent an emergency coronary bypass operation because of angiographic evidence of stent thrombosis with re-infarction. During in-hospital follow-up, 2 patients (5.7%) underwent an elective coronary bypass operation after successful stent implantation of the infarct-related artery because of existing severe multivessel coronary artery disease. Minor bleeding complications at the vascular access site occurred in 3 (8.6%) patients. No cerebrovascular or any other major bleeding complication occurred. One patient (2.1%) underwent repeat coronary angioplasty for restenosis and an elective coronary artery bypass operation was performed in one patient (2.8%) during the 294 +/- 150 days follow-up. The rate of target vessel revascularization was 14.3% and the event-free survival rate was 80%. Twenty-six patients (90%) had angiographic follow-up at six months, and stent restenosis was found in 5 (19.2%). This study demonstrates that heparin-coated Jostents are sale, with low in-hospital and long-term mortality rates for the treatment of failed thrombolysis in acute myocardial infarction. The angiographic restenosis and target vessel revascularization rates of this registry are also acceptable.

Objective: Chronic total occlusions are considered unfavourable for percutaneous balloon angioplasty because of the low rate of success and the high rate of restenosis. Stent implantation after recanalization of chronic total occlusions has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would improve the benefit of stenting in chronic total occlusions., Methods and Results: We analysed procedural and long-term clinical and angiographic follow-up results of 48 patients who underwent laser angioplasty followed by stent implantation for chronic total occlusions. The procedure was completed successfully in 46 patients (95.8%) in whom the lesion was crossed with a guidewire. We implanted 51 stents in 46 chronic total occlusions following laser debulking. During in-hospital follow-up 1 patient (2.1%) had Q wave, and 4 patients (8.7%) had non-Q wave myocardial infarction. Nine patients (19.5%) had repeat angioplasty for restenosis and one (2.1%) underwent coronary bypass operation at 6 months follow-up. Death or Q wave myocardial infarction did not occur during 6-month follow-up. Thirty-nine patients (85%) had angiographic follow-up at 6 months, and stent restenosis was found in 17 (44%) patients., Conclusion: These high rates of restenosis and target vessel revascularization in our study suggest that laser debulking before stent implantation does not improve clinical and angiogragic outcomes in chronic total occlusions.

Insulin is known to stimulate proliferation and migration of vascular smooth muscle cells. As the predominant mechanism of restenosis after stent implantation is neointimal tissue proliferation, one can expect a relationship between hyperinsulinemia and restenosis in these patients. The aim of this study was to determine whether hyperinsulinemia during oral glucose tolerance test is a predictor of the development of restenosis after stent implantation in nondiabetic patients. We prospectively studied 52 nondiabetic patients with effort angina who underwent elective stent implantation for single-vessel coronary artery disease. In order to increase the statistical power of the study, numerous exclusion criteria were applied. All patients were subjected to a 75 g oral glucose tolerance test a day before the stent implantation and underwent follow-up angiography 6 months later. Plasma insulin levels in fasting (6.77 +/- 1.57 vs. 5.36 +/- 1.35 micro U/ml; P = 0.005), at 30 min (102.48 +/- 10.6 vs. 47.74 +/- 12.75 micro U/ml; P = 0.001), 1 hr after (120.23 +/- 14.1 vs. 63.08 +/- 12.62 micro /ml; P = 0.001), 2 hr after (63.58 +/- 8.64 vs. 34.88 +/- 6.82 micro /ml; P = 0.001), and 3 hr after (25.71 +/- 5.65 vs. 23.02 +/- 4.61 micro /ml; P = 0.04) loading were significantly higher in patients with stent restenosis than in patients without stent restenosis. Insulin area and insulin area/glucose area were also significantly higher in patients with stent restenosis than in patients without (219.5 +/- 23.8 vs. 118.9 +/- 21.8, P = 0.001, and 0.62 +/- 0.09 vs. 0.33 +/- 0.06, P = 0.001, respectively). By multiple logistic regression analysis, insulin area during oral glucose tolerance test was found to be an independent predictor of stent restenosis (OR = 1.12; 95% CI = 1.01-1.25; P = 0.031). In conclusion, nondiabetic patients with hyperinsulinemia during oral glucose tolerance test have a high risk for restenosis after stent implantation, and performing this simple test before intervention may be useful for the prediction of stent restenosis., (Copyright 2003 Wiley-Liss, Inc.)