Nattawut Wongpraparut

Use of stents to treat kinks causing obstruction in a left internal mammary artery graft.

Left internal mammary arteries (LIMA) are used routinely as grafts to the left anterior descending coronary artery (LAD) in selected patients undergoing coronary artery bypass graft (CABG) surgery because of better long‐term patency rates. Pathology other than fibrointimal hyperplasia, accelerated atherosclerosis, or thrombus can sometimes cause obstructive lesions in such grafts. This report illustrates a kink in a LIMA graft to the LAD causing an obstructive lesion shortly after surgery and describes the subsequent management of this lesion with intracoronary stents. Cathet. Cardiovasc. Intervent. 46:223–226, 1999.

Incidence of bleeding complications associated with abciximab use in conjunction with thrombolytic therapy in patients requiring percutaneous transluminal coronary angioplasty.

The use of abciximab after full-dose failed thrombolytics within 15 hours of acute myocardial infarction significantly increases the risk of major bleeding complications.

Cisplatin Induced Localized Aortic Thrombus

Isolated aortic thrombus without atherosclerotic or aneurysmal change in the arch of aorta is relatively rare. We present a patient with a localized mobile aortic thrombus who also had cervical cancer and who had recently received chemotherapy with cisplatin and 5-fluorouracil (5-FU) and who presented with an embolic event to the right lower extremity. A 59-year-old woman with a history of cervical cancer stage IIB and essential hypertension received radiotherapy as an outpatient and 5-days prior to admission; she received inpatient chemotherapy with cisplatin at 50 mg/cm2 and 5-FU at 1 g/cm2 with uneventful hospital course. On the day of admission, the patient presented with a sudden onset of right leg pain, nausea and vomiting, and a cold right lower extremity absent pulse below the right femoral artery were noted. Abdominal aortography revealed evidence of an occluded distal common femoral artery (Fig. 1). In addition, there was also evidence of a thrombus in the popliteal artery. The patient subsequently underwent successful surgical thrombectomy. Numerous blood clots were removed from her leg. At surgery, the involved vessels were noted to have normal vascular walls. Pathologic examination confirmed the present of thrombus without evidence of atherosclerotic debris. Transesophageal echocardiography (TEE) identified a 2.5 × 1.2 cm mass located at the distal arch of the aorta (Fig. 2) and a 1.7 × 0.7 cm mobile component extending to the proximal part of the descending aorta (Fig. 3). The remainder of aorta characterized diffuse intimal thickening without significant atherosclerosis. Studies to exclude a hypercoagulable state were negative. Aortic thrombi are an important source of vascular emboli. Thrombi occur mostly in the distal aortic arch in the presence of severely dif-

Determinants of progression of aortic stenosis in patients aged ≥40 years

In summary, in patients with rapid progression of AS, 3 variables-patients on hemodialysis, those taking a calcium supplement, and those with elevated serum creatinine-were predictors of accelerated AS compared with variables in slow progressors.