Volume 4 - Issue 3 - May/June 2007
Editor's Corner »
CAS Reimbursement: Anatomy of a Retraction
On April 30, 2007, the Centers for Medicare and Medicaid Services (CMS) Coverage and Analysis Group (CAG) posted their Final Decision for 2007 regarding Medicare coverage for carotid stenting (CAS). In brief, they decided to:
• retract their proposed expansion of coverage to include asymptomatic high-risk surgical patients (HR);
• retract the proposed coverage exclusion of octogenarians;
• retract the proposed requirement for a surgical consultation to determine high-risk status for CEA;
• refine the requirements for facility recertification for CAS;
• reaffirm their previous
Original Contribution »
Rotational Atherectomy to Enable Sirolimus-Eluting Stent Implantation in Calcified, Nondilatable De Novo Coronary Artery Lesio
The sirolimus-eluting stent (SES) has demonstrated its angiographic and clinical efficacy in the suppression of coronary neointimal hyperplasia in a number of randomized clinical trials.1–7 Observational studies have supported the trial results in patient and lesion subsets that were excluded from these trials.8–14 The common denominator of all studies to date is that the targeted lesions were not subjected to any pretreatment other than predilatation. In particular, nondilatable calcified lesions were excluded from clinical trials and, to date, have not been studied
Case Study and Review »
Reversal of Refractory Hypertension due to the Goldblatt Kidney Phenomena from a Descending Aortic Dissection Using a Stent and
Introduction
Medical therapy for acute type B aortic dissections primarily involves reduction of aortic shear force by decreasing blood pressure. Rarely, if a dissection plane extends directly into a renal artery, the hypertension may be difficult to control and prevent optimal management of the dissection. We describe a case report of a patient who responded to percutaneous intervention of a dissection flap in a renal artery. Additionally, an off-label, FDA-approved filter device was utilized to prevent further progression of renal insufficiency.
Case Presentation
An 80-
Clinical Review »
Diagnostic Angiography of Specific Vascular Territories
Introduction The purpose of this article is to provide a concise review of fundamentals of angiography of major noncoronary arterial circulation. To put this in perspective, it is important to remind ourselves that angiography of an arterial tree is only warranted when the clinical presentation and noninvasive imaging have predicted a high likelihood of the presence of a flow-limiting lesion and the invasive study is used as a means of planning the treatment. Other indications for angiography include vasculitis and aneurysms. However, in a proper patient setting, when there are inconsis
Clinical Review »
Duplex Ultrasound Surveillance after Carotid Stent Angioplasty: When to Follow-up and What to Look for
Duplex ultrasonography, developed by Dr. Eugene Strandness, Jr. at the University of Washington in the 1970s, has evolved to become the primary noninvasive diagnostic technique for the evaluation of the extracranial carotid artery.1,2 By utilizing B-mode imaging to detail arterial anatomy and pulsed Doppler velocity spectra to assess blood flow characteristics, duplex ultrasound scanning provides a safe and accurate method to detect and grade the severity of atherosclerotic internal carotid artery (ICA) stenosis, both prior to and following intervention. Carotid duplex testing after
Clinical Review »
Image Guidance of Percutaneous Coronary and Structural Heart Disease Interventions Using a Computed Tomography and Fluoroscopy I
Introduction
Several studies have documented the inherent limitations of angiography and X-ray in the accurate diagnosis of coronary artery1,2 and structural heart disease. Traditionally, invasive coronary angiography has been performed with radiographic equipment that provides a simplistic, two-dimensional (2-D) representation of a patient’s more complicated three-dimensional (3-D) anatomy. This “flattening” of a 3-D image results in the generation of a final image that may be limited and inaccurate. To minimize these limitations, invasive cardiologists typically acqu
Clinical Review »
The Role of Embolic Protection Devices in Renal Angioplasty and Stenting
Introduction
Atherosclerotic renovascular disease is increasingly recognized thanks to technical improvements in duplex ultrasound, magnetic resonance angiography, CT scan, routine renal angiography during cardiac catheterization, coronary procedures and particularly in hypertensive or multivascular diseased patients. It represents an important public health problem.
A renal artery stenosis (RAS) is usually caused by atherosclerosis (80% of cases in patients over 40 years), and in rare cases is due to fibromuscular dysplasia (10% of cases and more often in young patients), arteriti
Clinical Review »
The Role of Embolic Protection Devices in Renal Angioplasty and Stenting Cont.
Discussion
RAS is increasingly diagnosed in patients suffering from hypertension and renal insufficiency and in multivascular diseased patients. PTRA is now the first treatment to be proposed with a high technical success rate, a low complications rate, a low restenosis rate, and good long-term anatomical results.
A large percentage of patients seem to benefit from the procedure concerning hypertension and renal insufficiency, with stabilization or improvement in RF, and in selected patients, RAS could slow the progression of renovascular renal failure and may delay the need for re
