Stents have revolutionized percutaneous coronary interventions (PCI), impacting on both acute and long-term results. However, despite improvements in stent design, stent deployment failure is not an unusual event. The aim of the present study was to assess the frequency and causes of stent deployment failure, as well as the outcome of these patients. Between 1997 and 2001, a total of 3,537 patients underwent stent-assisted PCI and delivery of 5,275 stents was attempted. In the majority of patients (118; 78.1%), stenting was performed as provisional; in the remaining 33 (21.8%) as a bailout procedure. A total of 175 (3.3%) stents in 151 (4.3%) patients failed. Failure to deliver the stent to the lesion site was the main cause in 139 patients (92%) and failure either to expand adequately the stent or premature disengagement of the stent from the balloon in only 12 patients (8%). Peripheral stent embolization occurred in 10 (0.3%) patients. Deployment of a different stent in place of the failed one was attempted in 122 patients and was successful in the majority (108; 88.5%). In-hospital major adverse cardiac events were observed in six patients (4%): three patients required emergency coronary artery bypass surgery, two had a myocardial infarction (MI), and one patient underwent urgent repeat coronary intervention. At a mean follow-up of 32.2 +/- 17.7 months, 22 major adverse cardiac event occurred in 17 patients (11.2%): 1 cardiac death, 3 patients had an MI, and 18 patients required target vessel revascularization. One-year event-free survival for the whole group was 91.2%. Patients with stent embolization did not have any major adverse cardiac or vascular events. Thus, the rate of stent deployment failure in our series was 3.3%, mainly due to failure to deliver the stent to the site. Another stent was successfully deployed in the majority of cases and these patients had favorable short- and long-term outcomes.

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SUMMARY Recent studies suggest that maximal Doppler velocities measured within the jets that form downstream from stenotic valves can be used to predict aortic valve gradients. To test whether the Doppler method would be useful for evaluation and management of pediatric patients with right ventricular outflow obstruction, we evaluated pulmonary artery flow before catheterization in 16 children with pulmonary valve stenosis. We used a 3. ALTHOUGH the clinical diagnosis of pulmonic stenosis is usually not difficult, mild pulmonic stenosis must occasionally be differentiated from aortic stenosis, ventricular septal aneurysm, or even functional flow murmurs. Additionally, clinical estimation of the severity of pulmonic stenosis can be difficult, especially in postoperative and very young patients. 1 Noninvasive echocardiographic diagnosis of pulmonic stenosis is sometimes difficult. Weyman and associates2 reported their experience with M-mode echocardiographic techniques and showed that a deep pulmonary "a" wave occurred in patients with pulmonary stenosis; however, false-negative diagnoses are common and no quantification of severity has been possible using this observation. of this prospective study was to assess the use of twodimensional echocardiographic Doppler techniques for providing noninvasively derived clinically useful information about the severity of pulmonary stenosis. Methods PatientsSixteen children, ages 1 month to 16 years (mean 4.3 + 2.5 years)( + SEM), 13 with clinically suspected isolated valvular pulmonic stenosis and three with minor pulmonary valve abnormalities (documented by subsequent angiography) accompanying atrial septal defects, were studied. Two of the 16 patients had undergone valvulotomy (neither of these had significant pulmonary insufficiency), and two patients were studied by Doppler pre-as well as postoperatively. All patients underwent cardiac catheterization within 12 hours of the ultrasonic study. Three patients were studied after premredication for catheterization; three patients were studied in the catheterization laboratory, and pressure and Doppler measurements were performed sequentially. During catheterization, after standard light sedation, pressure gradients were recorded during pullback across the pulmonic valve using an end-hole, fluid-filled catheter (

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Background. To assess the extent and nature of the dysfunction surrounding aneurysms of the left ventricle (LV), we examined the parameters of local and global three-dimensional shape, size, and

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Late stent thrombosis in the era of routine high-pressure stent deployment and combined antiplatelet therapy with thienopyridines and aspirin has become a rare but feared complication. We describe a patient with acute myocardial infarction due to late stent thrombosis 6 weeks after deployment of a sirolimus-eluting stent and 2 weeks after the discontinuation of clopidogrel. This is the first report of late thrombosis of a sirolimus-eluting stent.