Adjunctive therapies in the cath lab. Successful thrombolysis using the combination of tissue plasminogen activator and abciximab in an adult with Kawasaki's disease

Kawasaki's disease is an acute systemic vasculitic syndrome that primarily affects children. Coronary aneurysms are common vasculitic sequelae of Kawasaki's disease. Intracoronary thrombosis and embolization are potential consequences of coronary aneurysms. We describe our experience of successful thrombolysis using the combination of reduced-dose intravenous tissue plasminogen activator and abciximab as described in the Thrombolysis in Myocardial Infarction 14 trial (TIMI 14) to treat a patient found to have intracoronary thrombus at the site of aneurysm formation due to Kawasaki's disease.

Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent

A patient is described in which excimer laser percutaneous coronary intervention is performed inside a suboptimally expanded stent due to nondilatable calcified plaque. The use of excimer laser facilitated full expansion of the stent with a balloon.

Coronary angioplasty performed using the FullFlow mechanical dilatation-perfusion catheter: initial animal experience

We report our initial experience with an animal model, using a new mechanical catheter-based dilatation system, the FullFlow (FF) catheter. The primary purpose of this study was to compare coronary flow achieved using the FF perfusion catheter and a traditional balloon angioplasty perfusion catheter. Baseline average peak velocity (APV) measurements were obtained using the FloWire Doppler guide wire. Either a Surpass Perfusion balloon (PB) or an FF catheter was advanced to a coronary segment. Doppler measurements were made before, during, and after full device expansion. Simultaneous heart rate, EKG, and blood pressure readings were recorded. Significant 36.1% and 29% reductions in mean APV were found for PB when comparing baseline to device-up measurements and when comparing device-down to device-up measurements, respectively. In contrast, significant 12.2% and 18.5% increases were seen in mean APV for the FF. No significant differences were found in heart rate, systolic blood pressure, diastolic blood pressure, or ST-segment changes. The FF system produces superior downstream coronary perfusion with side-branch coronary patency compared with results using a contemporary perfusion balloon angioplasty catheter.