Simon J. Corbett

Use of the Venture wire control catheter to access complex coronary lesions: how to turn procedural failure into success.

AIMS To describe the impact of a steerable device on procedural success and times. The Venture wire control catheter (VWC-St. Jude Medical, Maple Grove, MN, U.S.A.), facilitates wire orientation providing excellent backup support and may therefore assist in cases in which conventional approaches have failed. METHODS AND RESULTS We describe all cases in which the VWC catheter was used at our institutions. The device was employed after prolonged attempts with standard wires had failed. We analysed procedural success and complication rates, as well as the impact of this device on procedural times. We evaluated 18 cases. The mean time from the first wire attempt to the end of the procedure was 58 minutes. Lesion crossing attempts with standard wires were performed for a mean time of 23 minutes (range 10-45 minutes). The VWC catheter was employed as the last resort, leading to procedural success in 14 cases. Lesion crossing with the VWC catheter was achieved in a mean time of four minutes (range one to 15 minutes). There were no device-related complications. CONCLUSIONS Our experience shows how the VWC catheter can turn procedural failures into successes, significantly impacting procedural times in different challenging scenarios. This device may represent an extremely useful addition to the interventionalists armamentarium.

Coronary Artery Rupture Caused by Stent Infection A Rare Complication

A 62-year-old man with a history of hypertension was admitted with unstable angina. Three years earlier, he had presented with a non–ST-segment–elevation myocardial infarction and had undergone percutaneous coronary intervention with a paclitaxel-eluting stent (3.0×20 mm; Taxus, Boston Scientific, Boston, MA) to the proximal left anterior descending coronary artery (Figure 1A). His initial ECG was normal, and his biomarkers were not elevated. Eight hours into his admission, he became pyrexial and developed chest pain associated with transient anterior ST-segment elevation. Emergency coronary angiography demonstrated aneurysmal dilatation at the proximal edge of the previous stent (Figure 1B). Because he had normal flow (Thrombolysis in Myocardial Infarction grade 3), his pain had settled spontaneously, and there was no evidence of a left ventricular regional wall motion …

Concurrent implantation of sirolimus- and paclitaxel-eluting stents in the same vessel.

Objective: To assess the safety and efficacy of concurrent implantation of sirolimus‐eluting (SES) and paclitaxel‐eluting (PES) stents in the same coronary artery. Background: When it is impossible to deliver multiple drug eluting stents (DES) of the same type, the operator must opt to implant a different DES or a bare metal stent. There are currently no published data evaluating this approach. Methods: We identified all cases in which one or more SES and PES were implanted in either the same lesion or adjacent segments of the same vessel during a single procedure between March 2003 and March 2005. Endpoints analyzed were; in‐hospital major adverse cardiac events (MACE), and follow‐up MACE (including stent thrombosis). Results: We identified 44 patients with 89 lesions. This was a complex cohort of patients with a median of 3.5 stents implanted, 3 lesions and 2 vessels treated and a median stent length implanted of 80.5 mm, while 83% of the lesions were type B2/C. Eight patients had peri‐procedural myocardial infarction. During follow‐up; 1 cardiac death occurred, no patients had a myocardial infarct or stent thrombosis, 11 underwent target lesion and vessel revascularization (25%) and 13 had a major adverse cardiac event (29.5%). Conclusions: In this cohort of patients, the concurrent use of SES and PES in the same vessel was associated with outcomes in keeping with the complexity of disease treated. Our data show that it is not unreasonable to implant different DES in the same vessel, although we would not advocate this as routine practice.

Paclitaxel-eluting stents

Percutaneous coronary intervention and stent implantation is rapidly becoming the most commonly used form of revascularization. The long term results of this procedure are limited by restenosis which is a phenomenon predominantly caused by proliferation of smooth muscle cells. Many devices and pharmaceutical agents have been unsuccessful in preventing this problem. Paclitaxel is an antiproliferative drug that has been extensively studied for the prevention of restenosis. This article will review the trial results of the currently available stent platforms and discuss some of the ongoing studies and future directions for the development of new paclitaxel-eluting stents.