Cath Lab Digest - October 2007 - (Page 29)

29 The author can be contacted at chenjackapollo@yahoo.com Note: This article underwent double-blind peer review by members of the Cath Lab Digest Editorial Board. While stent-induced plaque shifting usually results in side-branch compromise, our patient may have demonstrated a rare case of favorable snow-plowing into an adjacent wall, eventually liberating the posterolateral ostium. “Y-stenting,” “T-stenting,” “crush” stenting, and “kissing stents” have been proposed for this anatomic subset; however, none have resulted in uniform long-term patency of both branches.2-6 Interestingly, the opposite scenario occurred spontaneously in our patient. No attempt was made during the initial intervention to access the posterolateral branch, as its presence was concealed by the flush occlusion. Along with anti-thrombotic and anti-platelet therapy, the normalized perfusion from thrombectomy-assisted stenting of the main artery may have improved flow dynamics into the side-branch. That unintended simultaneous thrombectomy occurred in the posterolateral branch was unlikely, as it remained occluded at the end of the intervention. While stent-induced plaque shifting usually results in side-branch compromise, our patient may have demonstrated a rare case of favorable snow-plowing into an adjacent wall, eventually liberating the posterolateral ostium. Occasionally, a “stump” or ostial nub and/or delayed distal opacification of an occluded branch can be seen during angiography. An assessment should then be made regarding the potential benefits and feasibility of revascularization of that vessel. Had the side-branch been detectable during our initial intervention, a double-wire technique with either kissing balloons or dual-vessel stenting would probably have been considered. Ironically, it is unlikely that this more complicated procedure would have yielded a superior longterm result than the one obtained. Thus, while painstaking measures are often undertaken to preserve a diseased but patent side branch, occasionally simply treating the main vessel can unexpectedly open a previously occluded one. This branch liberation by deployment of “stent jail” is an unexpected, but certainly welcomed commuted sentence. ■ current techniques and outcome. J Interv Cardiol 2003;16: 507–513. 4. Sharma SK. Simultaneous kissing drug-eluting stent technique for percutaneous treatment of bifurcation lesions in large-size vessels. Cathet Cardiovasc Interv 2005;65:10–16. 5. Jim MH, Ho HH, Miu R, Chow WH. Modified crush technique with double kissing balloon inflation (sleeve technique): a novel technique for coronary bifurcation lesions. Cathet Cardiovasc Interv 2006;67:403–409. 6. Porto I, van Gaal W, Banning A. “Crush” and “reverse crush” technique to treat a complex left main stenosis. Heart 2006;92:1021. References 1. Chen JP. Dual lumen catheters: more than just aspiration. J Invasive Cardiol 2006;18(7):346. 2. Pan M, de Lezo Js, Medina A, et al. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J 2004;148:857–864. 3. Melikian N, Di Mario C. Treatment of bifurcation coronary lesions: a review of CLD Volunteer Survey Please complete the questions below and fax to 216-393-0445 or visit www.cathlabdigest.com to complete the survey online. 1. Do you volunteer to help raise awareness regarding heart health in your community? 2. If yes, how do you choose to donate your time regarding community heart health? Yes No 3. Does your hospital have a Heart Walk team? Yes No AHA affiliates all around the U.S. sponsor annual Heart Walks. Walkers can organize teams at the companies where they work or with family and friends. Walkers ask others to support their walk effort by sponsoring them with a donation to the American Heart Association. 4. Does your hospital follow the AHA’s “Get with the Guidelines” format for patient education and discharge planning? (“Get with the Guidelines” is a national program. Numerous studies have shown a reduction of mortality and morbidity the greater the number of guidelines that are implemented and adhered to.) Yes No 5. Prior to this survey, were you aware of the Go Red for Women campaign from the American Heart Association? Yes No 6. If yes, do you participate in the campaign in some way? Yes No 7. Prior to this survey, were you aware of the Start! Walking program from the American Heart Association? Yes No 8. If yes, do you participate in the campaign in some way? Yes No 9. Prior to this survey, were you aware of the Power to End Stroke campaign by the American Stroke Association? Yes No 10. If yes, do you participate in the campaign in some way? 11. Does your hospital plan to become Stroke Certified? Yes Yes No No Yes No 12. Prior to this survey, were you aware of the Alliance for a Healthier Generation? 13. If yes, do you participate in the campaign in some way? Yes No 14. Do you have school-age children who participate in Hoops for Heart or Jump Rope for Heart programs at their school? Yes No 15. If you have volunteered in the fight against heart disease, you are welcome to share thoughts about your experience: Thank you for completing our survey! Cath Lab Digest will publish the results in an upcoming 2007 issue. http://www.cathlabdigest.com http://www.cathlabdigest.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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