BACKGROUND AND OBJECTIVES: This prospective single-center randomized clinical study was designed to evaluate the long-term angiographic and clinical outcomes of elective treatment using the Crossflex (coil stent) as compared with the NIR (tubular stent) in patients with native coronary artery disease. SUBJECTS AND METHODS: 104 patients with 107 de novo discrete coronary stenoses were randomly assigned to the NIR stent (54 coronary stenoses) or the Crossflex stent (53 coronary stenoses). Six-month follow-up angiograms were obtained in 83 patients with 86 lesions (80%). Clinical follow up was available in all patients and the period averaged 23.1+/-5.3 months in the Crossflex group and 23.1+/-6.2 months in the NIR group. RESULTS: Procedural success was measured at 100% in both groups. There were no cases of stent thrombosis in either group. Although a higher loss index and more severe follow-up diameter stenosis occurred in the crossflex group, the angiographic restenosis rate was not significantly different in between the groups.
Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease ; Coronary Restenosis ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Prospective Studies* ; Stents* ; Thrombosis

Percutaneous transluminal coronary angioplasty (PTCA) is often used in the management of coronary artery disease and the advances in equipment, technichal skill and acquisition of operator experiences have improved initial success rates and reduced the frequency of complications. However, acute coronary occlusion is the most common and serious complication related to angioplasty and its several potential mechanisms are intracoronary thrombus, coronary artery spasm and coronary artery dissection. Accordingly,heparinization, intracoronary thrombolysis, re-PTCA, stent implantation and emergency coronary artery bypass grafting have been previously used for reopening of an occluded coronary artery during angioplasty. In this report we describe our experience in the management of acute coronary occlusion of left anterior descending artery caused by dislodgement of thrombotic material during PTCA by means of aspiration thromboembolectomy instead of medical therapy,re-PTCA and stent implantation.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Occlusion* ; Coronary Vessels ; Emergencies ; Spasm ; Stents ; Thrombosis

Kawasaki disease is an acute systemic vasculitis of unknown origin. Coronary aneurysm or ectasia is one of the most serious complications of Kawasaki disease. The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm. Percutaneous balloon angioplasty, rotational ablation, directional coronary artherectomy, stent insertion and coronary artery bypass graft can be used to treat coronary artery stenosis or occlusion. We describe a 6-year old boy who had an episode of Kawasaki disease with giant coronary artery aneurysm diagnosed at the age of 3 years. Surveillance echocardiogram showed giant coronary aneurysm with stenosis and large mural thrombus in the proximal portion of left main coronary artery. So we inserted two polytetrafluoroethylene(PTFE) covered graft stent without complication.
Aneurysm ; Angioplasty, Balloon ; Child ; Constriction, Pathologic* ; Coronary Aneurysm* ; Coronary Artery Bypass ; Coronary Disease ; Coronary Stenosis ; Coronary Vessels ; Dilatation, Pathologic ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Stents* ; Systemic Vasculitis ; Thrombosis* ; Transplants*

Acute giant coronary aneurysm after Kawasaki disease (KD) is a catastrophic complication that can be fatal and very difficult to manage. However, no fixed consensus has been reached for the management of super-giant coronary aneurysms in the acute setting. Here, we report the successful management of young children with super-giant coronary aneurysms after KD. Based on our experience, hemodynamic stabilization to prevent further coronary dilation or rupture and strict anticoagulation to avoid thrombus formation are mandatory in the management of this condition.
Child ; Consensus ; Coronary Aneurysm* ; Coronary Artery Disease ; Coronary Thrombosis ; Hemodynamics ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Rupture ; Thrombosis

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. RESULTS: The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). CONCLUSION: The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG.
Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Occlusion ; Coronary Vessels ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Ultrasonography, Doppler

BACKGROUND AND OBJECTIVES: There is little clinical data on the results of using Sirolimus-Eluting Stent (SES) for treating In-Stent Restenosis (ISR). We performed this study to evaluate the clinical outcomes for implanting SES for treating ISR in a real world hospital environment. SUBJECTS AND METHODS: A total of 30 patients with 32 ISRs (males: 73.3%, mean age: 60.2) (focal lesions: 21.9%, diffuse intra-stent lesions: 34.4%, proliferative lesions: 21.9%, total occlusions: 21.9%) were treated with SES after balloon predilation was performed. We evaluated the clinical results and the performed coronary angiography after 6 months. RESULTS: All the procedures were successful. The mean SES diameter and length were 3.0+/-0.3 mm and 27.1+/-5.5 mm, respectively, and the mean acute gain was 2.42+/-0.38 mm. No in-hospital major adverse cardiac events (MACE) were observed. Twenty five patients with 27 lesions (84.4%) underwent coronary angiography at their 6 month follow-up. The late loss and loss index were 0.41+/-0.56 mm and 0.18+/-0.22, respectively. The binary restenosis rate was 7.4% (2/27 lesions). The rate of target lesion revascularization was 3.7% (1/27 lesion). The incidence of MACE at 6 months was 3.3% (1/30 patient). CONCLUSION: Treating ISR with SES is a safe and effective procedure for reducing ISR without the occurrence of acute or sub-acute thrombosis.
Coronary Angiography* ; Coronary Artery Disease ; Coronary Restenosis ; Follow-Up Studies ; Humans ; Incidence ; Stents* ; Thrombosis

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.
Aneurysm ; Angina, Unstable ; Arteries ; Bundle-Branch Block ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Coronary Vessels ; Diagnosis ; Dyskinesias ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Hypokinesia ; Infarction ; Ischemia ; Phenobarbital ; Retrospective Studies ; Spasm ; Stroke ; Ventricular Fibrillation

Though axillo-femoral bypass has been the preferred procedure since the introduction of the procedure by Blaisdell1) in 1963 for high risk patients who have aorto-iliac occlusive disease, widespread use of axillo-femoral bypass was limited in the past because long-term patency rates were inferior to aortofemoral bypass. Multiple mechanisms were mentioned for its inferior patency but delayed stenosis of the inflow artery(not at anastomosis site) were not reported frequently. The authors experienced one case of inflow malfunction of axillo-femoral bypass due to subclavian artery stenosis in a patient with coronary artery disease and carotid artery stenosis. Subclavian artery stenosis was treated by percutaneous transfemoral angioplasty with improvement of symptom and ABI.
Angioplasty ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Artery Disease ; Humans ; Subclavian Artery ; Subclavian Steal Syndrome ; Transplants

BACKGROUND AND OBJECTIVES: Diffuse coronary artery disease presents physicians with a therapeutic challenge. The results after the use of bare metal stents (BMS) are limited by the high rate of restenosis. The introduction of drugeluting stent (DES) has prompted interventional cardiologists to treat long diffuse lesions with multiple overlapping stents. The purpose of this study is to determine the safety and efficacy of using multiple overlapping DESs for patients with diffuse coronary artery disease. SUBJECTS AND METHODS: From Jan. 2002 to Dec 2004, 83 consecutive patients suffering with diffuse coronary artery disease who underwent stent implantation with a minimum of 50 mm long BMSs or DESs were analyzed. The patients who had overlapping stents for dissection without diffuse lesion or they had BMS with overlapping DES were excluded from the study. The patients were divided into two group, the BMS group (group I: 29 patients, 63.0+/-8.2 years) and the DES group (group II: 56 patients, 60.6+/-9.3 years). The major adverse cardiac events (MACE), including death, myocardial infarction (MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG), were examined. RESULTS: The mean number of stents implanted was 2.19+/-0.4 in group I and 2.08+/-0.2 in group II, whereas the total mean length of the stents was 61.5+/-9.3 mm in group I and 61.4+/-9.1 mm in group II (p=NS). Procedural success was achieved for 89.7% of the patients in group I and for 96.3% of the patients in group II. No acute stent thrombosis was observed in both groups. All the patients underwent clinical follow-up (mean follow-up: 15+/-8.9 months, range: 7-36 months), and 66.2 % had an angiographic follow-up done at six months. During the follow-up, MACE was the cause of two deaths; there were thirteen TVRs and one CABG in group I, and there was one MI and five TVRs in group II. The TVR rate was lower in group II compared with group I (44.8% vs. 9.3%, respectively; p<0.001). Late stent thrombosis developed for one patient in group II. CONCLUSION: The implantation of overlapping DESs in patients with diffuse coronary artery disease is safe and this treatment is associated with better clinical outcomes than that with using BMS.
Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Disease ; Coronary Restenosis ; Coronary Vessels* ; Drug-Eluting Stents* ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Stents ; Thrombosis

The Kawasaki disease has been reported worldwide since the first description in 1967 in Japan. Approximately 20% of the children with untreated Kawasaki disease are believed to develop coronary artery aneurysm of which 2-3% progress to coronary artery stenosis. The Kawasaki disease rarely affects adults and accordingly, there have been only a few cases reported in literatures. The present case describes a successful surgical treatment of a 43-year-old female patient with coronary artery aneurysm and stenosis, which resulted from an episode of the Kawasaki disease that occurred 20 years earlier. The patient was well at 5 months followup.
Adult* ; Aneurysm ; Child ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Disease* ; Coronary Stenosis ; Coronary Vessels ; Female ; Follow-Up Studies ; Humans ; Japan ; Mucocutaneous Lymph Node Syndrome*