The Journal of Invasive Cardiology<br />
April 2002 issue

Dear Readers, This issue of the Journal of Invasive Cardiology includes several interesting articles. In the first research article, Dr. J. Richard Spears and collaborators from the Cardiovascular Research Laboratory, Wayne State University, TherOx Inc. in Irvine, California and Michigan State University present their preliminary study of aqueous oxygen hyperbaric reperfusion in a porcine model of myocardial infarction. They demonstrate that with their novel approach to catheter-delivered hyperbaric reperfusion of intracoronary aqueous oxygen, myocardial ischemia and reperfusion injury can be significantly reduced. Dr. Timur Timurkaynak and colleagues from the Gazi University Medical School in Ankara, Turkey compare markers of myocardial damage after apparently successful treatment using either conventional stenting with balloon pre-dilatation versus direct stenting without pre-dilatation. Although the researchers did find increased levels of cardiac troponin T levels in conventional stenting patients compared to those who had direct stenting, this difference did not reach statistical significance. Dr. Stephen Ellis of the Cleveland Clinic Foundation has provided an editorial commentary on this article, in which he reviews literature on direct stenting versus conventional stenting and studies looking at the effect of CK-MB rise on long-term outcome. He notes that prior work comparing direct stenting with the conventional approach has favored simpler lesions, limiting the usefulness of these studies. He also shows that Troponin may be too sensitive to myocardial tissue changes and that 5 times or higher the normal CK-MB has been associated with the most important negative events at long-term follow-up. Dr. Ta-Cheng Huang and associates from the Department of Pediatrics at the Veterans General Hospital-Kaohsiung in Kaohsiung, Taiwan describes their experience in using the 0.052´´ Gianturco coil to close large patent ductus arteriosus abnormalities. Although the technique has been shown to be quite successful in small arteries, they demonstrate promising results using the Gianturco coil in arteries greater than 4 mm. In an accompanying editorial, Dr. Ziyad Hijazi of the Department of Pediatrics at the University of Chicago Children’s Hospital reviews approaches that are available for the closure of large patent ductus arteriosus and concludes that the Amplatzer Duct Occluder, although more expensive, may provide a more reliable and safe method for closing large patent ductus arteriosus. In the fourth original research article, submitted by Drs. Shah, Martin and Topaz at the Medical College of Virginia Hospitals, Medical College of Virginia/Virginia Commonwealth University and McGuire VA Medical Center, the researchers report multiple cases in which they used excimer laser angioplasty to treat anomalous coronary arteries in patients presenting with acute coronary syndromes. The authors provide an in-depth look of the technical aspects related to the procedure and hints in treating this clinical presentation. In the final research article, Dr. Koichi Kishi and colleagues from Tokushima Red Cross Hospital in Tokushima, Japan discuss the predictors of recurrent in-stent restenosis. In their study of 197 consecutive patients who underwent coronary stenting, the major predictors identified included female gender, final diameter stenosis and diameter stenosis after predilatation. This issue also includes a special teaching collection focusing on the management of dissection and other complications following catheter-based intervention. In the first selection, Dr. Muthu Velusamy and colleagues describe an unusual presentation of spontaneous coronary dissection in a young woman that was apparently precipitated by retching. In addition to describing the treatment of this patient, they present a thorough discussion of the different ways in which spontaneous dissection can occur and the issues in treating this condition. In the second article, Dr. Steven Goldberg and collaborators describe the occurrence of late MI after surgical ligation of a giant coronary artery fistula. They show how thrombus that developed in a large blind pouch caused the recurrence of problems and required surgical closure for definitive treatment after failure with catheter-based techniques. In the last report, Drs. Ahmad Qaddour and Chanwit Roongsritong report an extremely rare occurrence of spontaneous dissection leading to acute MI that occurred in the internal mammary arteries of as patient who had quadruple bypass graft surgery. This issue includes two interesting case reports representing unusual clinical situations. In the first report, submitted by Dr. A. S. Mullasari and associates from the Institute of Cardiovascular Diseases, Madras Medical Mission, in Chennai, India, the authors describe their approach using stent implantation to treat hypertension caused by an iliac artery stenosis in a patient post renal transplantation. In the second case report, Dr. Ozer Badak and colleagues from the Departments of Cardiology and Hematology at the Dokuz Eylul University School of Medicine in Izmir, Turkey describe a patient who presented with acute MI and primary antiphospholipid syndrome that was successfully treated with primary stenting. The researchers provide an excellent discussion of the case and a brief review of the literature available on this unusual condition. This issue is completed with articles from three of our special sections. 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, Dr. Klein has invited Drs. Rami Doukky and James Calvin from Cook County Hospital in Chicago, Illinois to describe their development of risk stratification for patients presenting with unstable angina and non-ST segment elevation MI. The authors have provided a thorough examination of risk stratification models and cardiac markers used in evaluating non-ST elevation, and provide practical guidance in applying risk factor stratification to this challenging group of patients presenting with non-ST elevation acute coronary syndrome. We will publish part 2 of this article in our next issue. In the special section the Electrophysiology Corner, edited by Dr. Todd Cohen at Winthrop-University Hospital in Mineola, New York, Dr. Cohen has invited Dr. S. Hanna-Moussa and colleagues from Providence Hospital in Southfield, Michigan to discuss the challenge of implanting a dual chamber pacemaker via a persistent left superior vena cava utilizing a steerable stylet called the locator. Although this is a rare situation, this clinical presentation poses a problem for the cardiologist and the authors illustrate how to approach treating this situation. Finally, in the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Drs. Niccoli, Orr and Banning from the Department of Cardiology at John Radcliffe Hospital in Headington, Oxford, UK present a challenging case involving an extensive right coronary artery dissection following cutting balloon treatment of in-stent restenosis. Dr. Gregg Stone of the Cardiology Research Foundation, Dr. Scott Goldman of Mainline Health System, Dr. Barry George from Riverside Methodist Hospital, and Dr. Patrick Whitlow of the Cleveland Clinic Foundation have provided their perspectives on treating this case. It is my hope that all of the articles in this issue provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.