Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Apr 2005
Case ReportsPericardiocentesis ending in the superior vena cava.
Pericardiocentesis is associated with a wide range of complications. We describe a pericardiocentesis attempt ending in the superior vena cava through the route of liver parenchyma, hepatic vein, inferior vena cava, and right atrium.
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Catheter Cardiovasc Interv · Mar 2005
Comparative StudyLeft ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect.
Transcatheter closure of atrial septal defects (ASDs) is a safe and effective treatment. Over the past years, an increasing number of elderly patients (age > 60 years) have been admitted for transcatheter closure to prevent ongoing congestive heart failure from volume overload. However, recent data point to the risk of serious acute left ventricular dysfunction leading to pulmonary edema immediately after surgical or transcatheter ASD closure in some patients. ⋯ There were no significant differences in shunt, device size, or defect size between the two groups. Balloon occlusion of atrial septal defects identifies patients with left ventricular restrictive physiology before ASD closure. Intravenous anticongestive conditioning medication seems to be highly effective in preventing congestive heart failure after interventional closure of an ASD in the elderly patient with a restrictive left ventricle.
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Bilateral carotid stenosis is generally treated by staged stenting procedure and rarely simultaneously due to concerns about hemodynamic impairment from stimulation of the carotid sinus baroreflex (severe bradycardia, hypotension) and the risk of cerebral hyperperfusion syndrome. Most of the accounts of bilateral carotid stenting are of small series. The aim of this study was to evaluate the feasibility and safety of simultaneous bilateral carotid angioplasty and stenting (CAS) in comparison with staged procedure. ⋯ Among carefully selected patients, bilateral CAS is feasible simultaneously or the day after, with a safety and complication rate comparable to that of large published series of CAS or endarterectomies in high-risk patients. Nevertheless, careful monitoring of the patient, blood pressure, and heart rate is mandatory to avoid complications related to hyperperfusion syndrome. Routine use of neuroprotection device and meticulous technique should improve the outcomes of bilateral CAS.
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Catheter Cardiovasc Interv · Jan 2005
Case ReportsPercutaneous radial intervention for complex bilateral renal artery stenosis using paclitaxel eluting stents.
Techniques used in the coronary circulation may be useful in peripheral intervention. We report a case of bilateral renal artery stenosis treated via a radial approach by direct stenting with distal protection at a right ostial lesion and modified crush stenting at a left renal bifurcation lesion using paclitaxel-eluting stents.
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Catheter Cardiovasc Interv · Nov 2004
Case ReportsSafety and utility of intravascular ultrasound-guided carotid artery stenting.
Intravascular ultrasound (IVUS) is useful in evaluating coronary stent deployment. The aim of this study was to assess the safety and utility of IVUS in carotid artery stenting (CAS). Ninety-eight consecutive high-risk patients (107 arteries) underwent CAS. ⋯ We found IVUS imaging in CAS to be safe even prior to plaque dilatation. IVUS provides a more accurate assessment of stent dimensions, expansion, and apposition than angiography. Severe calcification by IVUS was associated with a higher risk of stroke.