Heidar Arjomand

Percutaneous coronary intervention: historical perspectives, current status, and future directions.

In the twenty-six years since Gruntzig introduced a simple balloon angioplasty technique, percutaneous coronary intervention has undergone extraordinary growth and has now surpassed bypass surgery in frequency of performance. Several critical breakthrough technologies account for this remarkable progress: intracoronary stents have increased success rates and reduced restenosis, adjunctive antiplatelet therapy has reduced periprocedural complications, and restenosis after stent placement has been effectively treated with local radiation. Most recently, drug-eluting stents coated with cell-cycle inhibitors have shown great promise for further reducing restenosis, possibly to negligible levels.

Right ventricular foreign body: percutaneous transvenous retrieval of a Greenfield filter from the right ventricle--a case report.

A 55-year-old man suffered head injury during a motor vehicle accident. He underwent a prophylactic inferior vena cava Greenfield filter placement. The filter migrated and lodged in the right ventricle at the level of the tricuspid valve. Successful percutaneous, transvenous retrieval of the Greenfield filter from the right ventricle was carried out.

Comparison of saphenous vein graft intervention with bare stents plus distal protection versus membrane-covered stents without distal protection: Data from SAFER and roll-in phase of BARRICADE trials

Background: Percutaneous interventions in degenerated saphenous vein bypass grafts are associated with a high risk of periprocedural distal embolization resulting in myocardial infarction. We report the in-hospital outcomes of placement of a new polytetrafluoreoethylene-covered stent in the first US experience with this device. Methods: As palt of a prospective randomized multicenter trial (BARRICADE Trial), 88 patients were included in the roll-in phase with 104 lesions in SVGs. The use of distal protection devices was left to the discretion of the operator. In-hospital technical success, complications rats, and the incidence of MACE (death, Q-wave or non-Q-wave myocardial infarction (Ml), and target vessel revascularization (TVR) were analyzed. Results: A total of 88 patients with a mean age of 67 years received 111 covered stents for 104 stenoses in vein grafts 10.2 * 5.8 years after bypass surgery. Clinical characteristics included: diabetes (35%), hyperlipidemia (92%), hypertension (77%), and smoking (67%). Lesions characteristics included: reference diameter 3.7 * 0.4 mm, lesion length 15.1 f 5.9 mm, percent stenosis 84.2 r 10.2%. Stent placement was successful in all patients. GP Ilb/llla inhibitors were used in 66% and distal protection devices in 31% of cases. Complications and MACE rates are shown in the table below. Conclusion: The use of PTFE-covered stems appears to be safe and effective in treating high risk lesions in SVGs, with a relatively low risk of non-Q wave myocardial infarction.