Editor`s Message - April 2003

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports with brief reviews, and articles from the Journal special sections “Acute Coronary Syndromes”, “Interventional Pediatric Cardiology” and “Clinical Images”. The first research article, by Dr. Dardas and colleagues from the Thessaloniki Heart Institute, St. Luke’s Hospital in Thessaloniki, Greece describes their novel approach to treating patients presenting with what appears to be bifurcation lesions, but are actually a false bifurcation of lesions in a main branch with a non-diseased sidebranch. Since the non-diseased sidebranch often is compromised with plaque redistribution, they show how using primary stenting of the main vessel with simultaneous kissing balloon of the sidebranch avoids this “snowplough effect”. Dr. Colombo of the editorial board has provided a commentary on this research paper. The second research article, submitted by Dr. Ali and colleagues from St. John’s Hospital and Medical Center in Detroit, Michigan focuses on an infrequent yet potentially disastrous complication of GP IIb/IIIa inhibitors in which diffuse pulmonary hemorrhage occurs. Their findings indicate that pre-PCI evidence of pulmonary congestion, pulmonary abnormalities and use of high heparin doses may be associated with patients who ultimately develop diffuse pulmonary hemorrhage. Drs. Dangas and Iakovou of the Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute in New York have provided a commentary on this paper, further characterizing the life-threatening aspects of this complication following GP IIb/IIIa therapy. In the third original research paper, Dr. Diamantopoulos and associates from the University Hospital in Leuven, Belgium present their research investigating changes in arterial wall temperature after coronary stent implantation in pigs. They found that temperature in the stented area was lower than adjacent areas immediately after implantation, but within 5 days was significantly warmer, with increased macrophage activity, which decreased by day eight. Their findings may be helpful in guiding early therapy to decrease inflammation caused by stent implantation. The fourth research article, submitted by Dr. Cho along with collaborators from Loyola University Medical Center in Chicago, University Hospital in Zurich, Switzerland, University of Michigan Medical Center in Ann Arbor and the Cleveland Clinic Foundation, compares the use of Nitinol stents with balloon angioplasty in the treatment of total occlusions in superficial femoral arteries. Stenting was associated with reduced translesional pressure gradients and patients required less adjunctive medical therapy following the procedure. Dr. Criado, a member of the Journal editorial board, has provided a commentary on the paper from Cho et al. The last original research article is also a selection from the Interventional Pediatric Cardiology special section. Dr. Rao and colleagues from the Saint Louis University School of Medicine/Cardinal Glennon Children’s Hospital, St. Louis, Missouri and the University of Texas-Houston Medical School/Memorial Hermann Children’s Hospital, Houston, Texas, discuss their experience with management strategies of the neonate and young infant with native aortic coarctation; they conclude that balloon angioplasty is an excellent alternative to surgical intervention in the management of native aortic coarctation in neonates and young infants. This issue also includes case reports on interesting topics, three of which include brief reviews of the literature. In the first case report, Dr. Bhakta and associates from the Krannert Institute of Cardiology, Clarion Cardiovascular Center, and Indiana University in Indianapolis, Indiana present a patient with complete sinus inversus with bicuspid aortic valve stenosis and describe their evaluation approach emphasizing technical aspects of left and right heart catheterization. The second case report, submitted by Drs. Ito, Ojio and Suzuki from the Toyohashi Heart Center in Toyohashi, Japan shows a novel use of the cutting balloon in treating coronary artery dissection that occurred during a PCI procedure. In a case report and brief review, Dr. Mann and colleagues from the Wake Heart Center in Raleigh, North Carolina describe their successful treatment of a severely diseased saphenous vein graft using initial rheolytic thrombectomy followed by coronary stenting. The next case report and review, submitted by Drs. Schiele, Weber and Klauss of the Medizinische Klinik-Innenstadt, University Hospital in Munich, Germany, describes the morphological and functional assessment of a very rare coronary anomaly discovered in a heart transplant patient. The last report is a multiple case report and discussion submitted by Dr. Bendok and collaborators from State University of New York at Buffalo, Lenox Hill Heart and Vascular Institute and the Miami Cardiac and Vascular Institute. This collection of case reports demonstrates the safety and effectiveness of the cutting balloon in treating in-stent restenosis in the carotid arteries. In the first of two special sections featured in this issue, Acute Coronary Syndromes, which is edited by Dr. Lloyd Klein from the Rush Heart Institute at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois, Dr. Klein has invited Dr. Ajay Tuli and collaborators from Emory University in Atlanta, Georgia to present their experience in using excimer laser coronary atherectomy to debulk lesions with in-stent restenosis prior to the use of brachytherapy. The authors have also provided an excellent review of the literature on the potential utility of adjunctive debulking for treating in-stent restenosis. In the Clinical Images section, edited by Dr. David Rizik from Scottsdale HealthCare Hospitals, Dr. Rizik and his colleagues present correlated angiographic and IVUS images after a cutting balloon and following stent placement. It is my hope that all of the articles in this issue of the Journal provide healthcare professionals with valuable information that is useful in the daily care of patients with cardiovascular disease.