Doppler-derived coronary flow reserve accurately predicts the presence of exercise-induced ischemia on stress 201Tl imaging, and coronary angiography does not reliably assess the physiological significance of an intermediate coronary stenosis.
Late stent thrombosis has not been reported in the absence of prior coronary brachytherapy. We reviewed our experience in 1,855 consecutive patients who received at least one stent and did not receive coronary brachytherapy. Half of all stent thromboses occurred within the first week and nearly 65% (22) occurred within 15 days. The incidence of stent thrombosis within this traditional time frame was 1.2%. An additional 12 patients, however, presented with stent thrombosis between 33 and 270 days post-procedure (mean ؍ 72.9 ؎ 23 days). The true incidence of stent thrombosis was therefore 1.8% (34/1,855). There were three bypass operations, one stroke and two deaths in the late stent thrombosis group. Late stent thrombosis is an unusual but serious complication in patients who have not received coronary brachytherapy. Intracoronary radiation may potentiate a phenomenon that already occurs after stent deployment. Prolonged treatment (6 -12 months) with anti-platelet agents should be considered after percutaneous intervention with coronary stents. Cathet Cardiovasc Intervent 2001;53:23-28.
Rest phasic Doppler flow velocity indexes are not useful for evaluating stenoses in the right coronary artery proper before or after angioplasty. In contrast to the right coronary artery proper, diastolic predominant flow is observed in the posterior descending and posterolateral coronary arteries. The utility of measuring hyperemic Doppler flow velocity indexes, such as distal coronary flow reserve, for assessing right coronary artery stenoses merits further investigation.
A case of a unipolar surgical electrocautery-induced runaway pacemaker is described. The single chamber ventricular pacemaker began firing at 140 beats/min with intermittent capture and the abnormal rhythm persisted after cessation of the electrocautery. Emergent explanation of the pulse generator was required.
Late stent thrombosis has not been reported in the absence of prior coronary brachytherapy. We reviewed our experience in 1,855 consecutive patients who received at least one stent and did not receive coronary brachytherapy. Half of all stent thromboses occurred within the first week and nearly 65% (22) occurred within 15 days. The incidence of stent thrombosis within this traditional time frame was 1.2%. An additional 12 patients, however, presented with stent thrombosis between 33 and 270 days post-procedure (mean = 72.9 +/- 23 days). The true incidence of stent thrombosis was therefore 1.8% (34/1,855). There were three bypass operations, one stroke and two deaths in the late stent thrombosis group. Late stent thrombosis is an unusual but serious complication in patients who have not received coronary brachytherapy. Intracoronary radiation may potentiate a phenomenon that already occurs after stent deployment. Prolonged treatment (6-12 months) with anti-platelet agents should be considered after percutaneous intervention with coronary stents.
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