Editor’s Message (December 2002)

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, articles from the Journal special sections “Acute Coronary Syndromes” and “Intervention in Peripheral Vascular Disease”, and a summary of the discussion on treating patients with bifurcation disease from the International Andreas Gruentzig Society Meeting held in February of 2002. The first research article, submitted by Dr. James Orford and colleagues from the Division of Cardiovascular Diseases at the Mayo Clinic in Rochester, Minnesota, presents results from Mayo Clinic on the safety and efficacy of the cutting balloon. The authors show that excellent results can be achieved in several clinical presentations, most notably for treatment of in-stent restenosis. Drs. Francis Almeda and Lloyd W. Klein of Rush-Presbyterian-St. Luke’s Medical Center have provided a commentary on the current status of cutting balloon technology. They discuss the Orford et al. study and other recent trials, concluding that the true benefit of the cutting balloon still needs to be established, especially with the advent of drug-eluting stents. The second research article is also from the Mayo Clinic, submitted by Christopher Crocker and collaborators from the Division of Cardiovascular Diseases and Internal Medicine. In this article, the authors report their experience using the Closer™ suture-mediated vascular closure device following diagnostic angiography. Hemostasis was achieved in a high percentage of patients with most being able to ambulate immediately following the procedure. Dr. Zoltan Turi of the Journal editorial board has provided a commentary on the Crocker et al. article. He also provides an excellent point-by-point discussion of arguments in favor of using closure devices to accomplish immediate ambulation in these patients. In the third original research article, Dr. Pavel Cervinka and colleagues from the Faculty Hospital Hradec Kralove in the Czech Republic describe a series of patients with coronary bifurcation lesions that were treated with stent implantation in the primary vessel and balloon angioplasty on the secondary vessel. They showed in follow-up that patients had a low rate of target lesion revascularization. Dr. Ran Kornowski and associates from the Cardiac Catheterization Laboratory and Cardiology Department at Rabin Medical Center in Petach Tikiva, Israel submitted the last research article included in this issue of the Journal. They report on their results using the 6 French Perclose suture closure device in patients following percutaneous coronary intervention. In comparison to a manual compression control group, the Perclose patients achieved more rapid hemostasis, even in the setting of more frequent use of GP IIb/IIIa inhibitor agents. This issue of the Journal also includes two case reports with brief reviews of the literature and three interesting case reports representing unusual clinical presentations. In the first case report, submitted by Dr. Deepak Jain and colleagues from the Medizinische Klinik II, Universitatsklinikum Lubeck in Lubeck, Germany, describes the use of brachytherapy in an elderly patient presenting with hypertrophic cardiomyopathy and in-stent restenosis. In the second case report, Drs. Shammas, Roberts and Early from the Genesis Heart Institute, Cardiovascular Medicine, P.C. in Davenport, Iowa demonstrates their use of extracorporeal membrane oxygenation to provide hemodynamic support during the treatment of an unprotected left main stenosis in a patient with a totally occluded right coronary artery and severe left ventricular dysfunction. The authors provide an excellent discussion of treatment alternatives and technical considerations in this challenging clinical scenario. In the next case report, submitted by Drs. Don Lee and J. Daniel Garnic from Glendale Memorial Hospital in Glendale and the USC School of Medicine, the authors describe their approach to the management of an elderly patient who presented with acute myocardial infarction with cardiogenic shock who had treatment of an unprotected left main stenosis with a stent. Three-year follow-up showed that the stent was still open, demonstrating that catheter-based intervention can be a viable treatment alternative in these kinds of high-risk cases. The fourth report, submitted by Drs. Iancu, Literat and Bedeleanu from the Heart Institute in Cluj-Napoca, Romania, describes their successful treatment of a case of juvenile rheumatic mitral stenosis associated with aortic coarctation. The last case report, from Drs. Ashby, Conditt and Dangas from the Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute in New York, demonstrates the value of ultrasound in correctly diagnosing coronary artery spasm associated with moderately severe coronary disease in the proximal left anterior descending artery of a 42-year-old female. Two of our special clinical sections are featured in this issue. In the first special section, Acute Coronary Syndromes, edited by Dr. Lloyd Klein from the Section of Cardiology, Rush Heart Institute at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois, Drs. Srinivas, Vakili and Brown from the Hochman Division of Cardiovascular Interventions at Beth Israel Medical Center in New York analyze outcomes achieved with primary angioplasty done within 6 hours of myocardial infarction compared to treatment done between 6 and 23 hours. Using the New York State registry, they found that there was not a significant difference in in-hospital mortality or major adverse cardiac events between the two groups. In the second special section, Interventions in Peripheral Vascular Disease, edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital/Medstar Health in Baltimore, Maryland, Dr. Nicholas Morrissey and colleagues from the Division of Vascular Surgery at Mt. Sinai School of Medicine in New York discuss the negative consequences of bilateral hypogastric artery sacrifice when treating abdominal aortic aneurysms and evolving methods to avoid these undesirable outcomes. This issue also includes a transcript of the discussion on treatment of patients with bifurcation disease that occurred at the International Andreas Gruentzig Society meeting held in St. Lucia in February of this year. This lively discussion demonstrates that there are a number of unresolved issues in managing this challenging clinical situation, which is highlighted in several of the articles included in the current issue of the Journal. It is my hope that all of the articles in this issue of the Journal provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.