Surgical endarterectomy has been shown to be superior to medical treatment in the management of severe carotid stenosis. Endarterectomy, although effective, does have limitations, and percutaneous transluminal angioplasty with stent may offer an alternative modality of treatment. We report on a patient with severe coronary disease that femoral arterial cannulation was not possible due to aorto-femoral shunt operation and absent pulse. The transradial approach was used for aortography, bilateral carotid angiography and successful elective stent deployment in the left internal carotid artery. The transradial approach might be useful alternative in case of problems with femoral approach.
Angiography ; Angioplasty* ; Aortography ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Catheterization ; Coronary Disease ; Endarterectomy ; Humans ; Stents*

Coronary stent embolization is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during the procedure. We report a case of systemic embolizations of two coil stents during the primary PTCA in acute myocardial infarction, who were treated successfully with a double wire helix technique and a gooseneck snare. Although in our experience this rare complication did not produce any clinical complications, care should be taken to prevent this possibility, especially in patients with significant vessel tortuosity, calcification, total occlusion, or mild stenosis proximal to the target lesion.
Constriction, Pathologic ; Humans ; Iliac Artery* ; Ischemia ; Myocardial Infarction ; SNARE Proteins ; Stents*

BACKGROUND AND OBJECTIVES: Practical concerns about transradial approach are increasing in consideration of high procedural success rate, low local complications, and patient's convenience. There was no available data about repeated-use of radial artery for coronary procedures. We evaluate the changes of radial arterial diameter and procedural outcomes of repeated transradial procedure. MATERIALS AND METHOD: Of consecutive 1771 transradial coronary procedures, 117 patients received repeated transradial procedures through the same radial artery. Radial arterial diameter, vascular access time and procedural outcomes were evaluated in between the group of first-use and repeated-use of radial artery. RESULTS: Among 117 patients of second transradial coronary procedure in the repeated-use group, 47 patients (41.6%) underwent coronary intervention and 66 patients (58.4%) underwent coronary angiography. The right radial approach was used in 82.9% of the cases. There was no significant difference in radial artery mean diameter between pre-procedure and 1 day after procedure in patients with first-use and repeated-use group. There was no significant change of radial arterial diameter after first-use depending on the SAR (the ratio of sheath outer diameter to radial artery inner diameter). However, after repeated-use of radial artery, there was significant reduction of radial arterial diameter 1 day after procedure in the patients with SAR more than 0.9 (p<0.05). In repeated-use group, the mean radial arterial diameter was 2.63 +/- 0.35mm mm before the procedure and 2.51 +/- 0.29mm during follow-up (136 +/- 123 days) (p<0.05). There was no significant difference of the vascular access time between the first-use and repeated-use procedures (2.9+/-3.1 vs 3.3+/-3.6 minutes, p<0.05). The procedural success and vascular complication rate of repeated-use of radial artery were as similar to those of the first-use, but total occlusion of radial artery was higher in the repeated-use group (2.6% vs 0.7%, p<0.05). CONCLUSION: The diameter of radial artery after transradial procedures was significantly reduced during follow-up and the incidence of asymptomatic radial artery occlusion was more frequent after repeated-use. However, repeated-use of radial artery was feasible in most patients with high procedural success rate and low vascular complications.
Coronary Angiography ; Follow-Up Studies ; Humans ; Incidence ; Radial Artery*

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.
1-Methyl-3-isobutylxanthine* ; Angina Pectoris ; Angioplasty, Balloon ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Dimethyl Sulfoxide ; Formaldehyde ; Humans ; Hyperplasia ; Ketamine ; Male ; Muscle, Smooth, Vascular ; Neointima ; Phenobarbital ; Phosphoric Diester Hydrolases ; Polymers ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.
1-Methyl-3-isobutylxanthine* ; Angina Pectoris ; Angioplasty, Balloon ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Dimethyl Sulfoxide ; Formaldehyde ; Humans ; Hyperplasia ; Ketamine ; Male ; Muscle, Smooth, Vascular ; Neointima ; Phenobarbital ; Phosphoric Diester Hydrolases ; Polymers ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Recent data showed prolonged administration of direct thrombin inhibitor might be needed to counteract the persistent thrombin activity and reduce the neointimal hyperplasia after arterial injury. We hypothesized that prolonged administration of LB30057, orally active direct thrombin inhibitor, might inhibit the vascular smooth muscle cell (SMC) proliferation in vitro and neointimal hyperplasia in rat carotid injury model. METHODS: In phase I, thrombin stimulated [methyl-3H] thymidine uptake was measured after LB30057 administration in cell culture study using rat aortic SMC. In phase II, LB30057 (low-dose: 5mg/kg, bid: mid-dose: 25mg/kg, bid: high-dose: 50mg/kg, bid) or placebo was administrated orally twice a day starting from 30minutes before injury until sacrifice for 14days in separated 2 sets of experiment. The histo-morphometric analysis for lumen area, intimal area, medial area, intima-to-medial ratio was performed. RESULTS: In vitro rat aortic SMC culture study, LB30057 inhibited thrombin-induced thymidine uptake. The mean neointimal area was significantly less in high-dose and mid-dose group than placebo group (high-dose vs. placebo: 0.14+/-0.02mm2 vs. 0.25+/-0.02mm2: mid-dose vs. placebo: 0.16+/-0.02mm2 vs. 0.29+/-0.03mm2, p<0.005) respectively and the mean ratio of neointima to medial area were significantly less in high-dose and mid-dose group than in placebo group (high-dose vs. placebo: 1.20+/-0.57 vs. 1.94+/-0.67, mid-dose vs. placebo: 1.58+/-0.29 vs. 2.39+/-0.27, p<0.05). There was no significant difference in the mean area of internal elastic lamina, external elastic lamina and mean luminal area between groups. In 2nd set experiment, the mean neointimal area (placebo: 0.29+/-0.03mm2, mid-dose: 0.16+/-0.02mm2: p<0.005), the mean area of internal elastic lamina and external elastic lamina were significantly less in mid-dose group than in placebo group. The mean ratio of neointima to medial area was significantly less in mid-dose group(1.58+/-0.29) than in placebo group (2.39+/-0.27) (p<0.05). CONCLUSION: LB30057 inhibits SMC proliferation in a dose dependent manner. Prolonged 14-day oral administration of LB30057 is effective in reducing the neointimal hyperplasia in rat carotid balloon injury model.
Administration, Oral ; Animals ; Cell Culture Techniques ; Cell Proliferation* ; Hyperplasia* ; Muscle, Smooth, Vascular* ; Neointima ; Phenobarbital ; Rats* ; Thrombin* ; Thymidine

BACKGROUND AND PURPOSE: Hyperhomocysteinemia is supposed to be a risk factor for vascular occlusive disease. We want to evaluate the relationship between plasma homocysteine and the severity of coronary artery disease (CAD). METHODS: In 121 consecutive patients (men:62%: age:60+/-10 years) undergoing coronary angiography, plasma homocysteine, vitamin B(12), vitamin B(6) and folate levels were measured and angiographic findings were evaluated for the number of diseased vessels (diameter stenosis 50%), severity of stenosis of CAD and extent of CAD. Extent of CAD was defined as an index derived by assigning a score of 0-3 per segment depending on the proportion of lumen length irregularity and dividing the sum by the number of visualized segments. RESULTS: Twenty-two patients had normal coronary artery: 35 patients, minimal CAD (diameter stenosis < 50%): 30 patients, 1 vessel disease (VD): 22 patients, 2VD and 12 patients, 3VD. Homocysteine levels w+re not significantly different between the groups (normal:7.6+/-4.2 mmol/L: minimal CAD:8.4+/-3.1mmol/L: 1VD: 8.0+/-4.8mmol/L: 2VDs: 10.2+/-6.0 mmol/L: 3VDs: 9.2+/-5.3 mmol/L). There was no relation between the stenosis scores of CAD and homocysteine levels (r=0.1). The extent scores of CAD were weakly correlated to the plasma homocysteine levels (r=0.22, p<0.05) and low density lipoprotein (LDL) cholesterol levels (r=0.28, p<0.01), and reversely correlated to high density lipoprotein (HDL) cholesterol levels (r=-0.31, p<0.01). The plasma homocysteine levels were reversely correlated to vitamin B12 (r=-0.27, p<0.01) and folate (r=-0.23, p<0.05) levels. In conclusion, the plasma homocysteine level was weakly but significantly correlated with the extent of CAD, not with the severity of stenosis.
Atherosclerosis ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Folic Acid ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Lipoproteins ; Plasma* ; Risk Factors ; Vitamin B 12 ; Vitamins

Coronary artery perforation is a rare and serious complication in coronary angioplasty. Some patients complicated by coronary perforation may develop cardiac tamponade, which is generally due to massive hemorrhage in the pericardial space between the epicardium and the pericardium. We report a case of coronary artery perforation producing impending tamponade, which was successfully treated by transcatheter embolization of distal circumflex artery using polyvinyl alcohol.
Angioplasty ; Arteries* ; Cardiac Tamponade ; Coronary Vessels ; Hemorrhage ; Humans ; Pericardium ; Polyvinyl Alcohol* ; Polyvinyls*

BACKGROUND AND PURPOSE: The radial artery has currently been regarded as a useful vascular access site for coronary procedures. We want to evaluate the incidence and clinical significance of anomalous branching pattern and tortuosity of radial artery. MATERIALS AND METHOD: From May 1997 to May 1999, retrograde radial artery angiography was performed in 1191 cases. Branching anomaly and tortuosity of upper extremity artery, procedure times and local vascular complications were analyzed. RESULTS: 1) Anomalous radial arterial branching was found in 3.2%. Most common one was high origin of the radial artery (2.4%). 2) Tortuosity of radial artery was found in 4.2%. Most common tortuosity were S shape in 1.8% and omega shape in 1.8% of cases. 3) Cross over to other artery, radial artery occlusion and perforation occurred in 24 cases, 6 cases and 4 cases, respectively. Prolonged procedure times, crossover to other artery and radial artery perforation was related with tortuosity of radial artery, not with anomalous branching. CONCLUSION: The incidence in branching anomaly and tortuosity of radial artery was not frequent in our study. Radial artery tortuosity was associated with old age, prolonged procedure time and radial artery perforation. In selected cases, pre- or intra-procedural angiographic assessment of radial artery might be helpful in performing safe procedure.
Angiography ; Arteries ; Incidence ; Radial Artery* ; Upper Extremity

Behcet's disease is a disorder of a multisystemic involvement with unknown etiology. Involvement of the cardiovascular system and intestinal tract are rare, but serious complications. We present a case with Behcet's disease demonstrating aneurysm of the abdominal aorta as well as hemorrhagic ileal ulcerative lesions and requiring surgical treatment.
Aneurysm* ; Aorta, Abdominal* ; Aortic Aneurysm ; Behcet Syndrome ; Cardiovascular System ; Ileitis ; Ileum* ; Ulcer*