Direct stenting without predilation in selected lesions seems to be a safe and successful procedure that provides a way to contain cost and to shorten radiation exposure time.

The present study shows that a longer stented segment is an independent predictor of restenosis without an influence on the risk of subacute thrombosis.

This preliminary series supports the feasible use of the PercuSurge GuardWire for retrieval of plaque debris and prevention of embolization in degenerated SVGs. The good tolerance of temporary occlusions without angiographic or clinical evidence of distal embolization represents encouraging early findings.

n developed countries, the incidence of end-stage renal disease (ESRD) is increasing at a dramatic rate. 1 Cardiac diseases are responsible for almost 50% of allcause mortality in patients with ESRD, with approximately 20% of all cardiac deaths stemming from fatal outcomes of acute coronary syndrome. 2 Previous studies 3-5 have shown high in-hospital and long-term adverse cardiac event rates after percutaneous coronary intervention (PCI) and coronary artery bypass grafting in patients with ESRD.Recent randomized trials 6,7 have demonstrated that drugeluting stents (DES) substantially reduce in-stent restenosis compared with bare metal stents (BMS), but patients with ESRD were excluded. Thus it remains unclear whether DES has an advantage over BMS in this patient subset. The present study evaluated clinical and angiographic outcomes of PCI with sirolimus-eluting stents (SES) in dialysis patients. Methods PatientsBetween and Asahi Chuo Hospital) were enrolled. All patients had established ESRD and had already been on hemodialysis before PCI. A control group for comparison was composed of the same number of consecutive patients (n=54) on hemodialysis from each hospital who underwent PCI using BMS both during the same time period (n=25) and before the introduction of SES (n=29). Some patients had multivessel stenting. Thus there were 69 and 58 lesions treated with SES and BMS, respectively. This study was approved by the local council on human research at each hospital. PCI was performed after written informed consent was given. All patients underwent stenting according to current guidelines. 8 Glycoprotein IIb/IIIa inhibitors was not used because they are not available in Japan. Rotational atherectomy was used at the operator's discretion. SES was usually used after the introduction of SES unless difficulty in delivery was anticipated, non-cardiac surgery had been planned, or there was a contraindication to SES. Operators tried to fully cover the angiographic lesion, especially when a SES was implanted. After stent implantation, angiographic optimization was performed using high-pressure balloon dilation to achieve an acceptable angiographic result with <20% residual stenosis by visual estimate. All patients received aspirin 100 mg daily before the procedure and continued on it indefinitely. Patients were treated concomitantly with ticlopidine 100 mg twice daily at least 3 months, 9 because clopidogrel had not been available in Japan. Angiographic follow-up was performed at 9 months or earlier if noninva- Impact of Drug-Eluting Stents on Clinical and Angiographic Outcomes in Dialysis PatientsNaoki Ishio, MD; Yoshio Kobayashi, MD; Hideo Takebayashi, MD*; Yoshihiro Iijima, MD**; Junji Kanda, MD † ; Takashi Nakayama, MD; Nakabumi Kuroda, MD; Joseph De Gregorio, MD † † ; Yukinori Kouno, MD**; Masaru Suzuki, MD † ; Seiichi Haruta, MD*; Issei Komuro, MD Background It remains unclear whether sirolimus-eluting stents (SES) have an advantage over bare metal stents (BMS) in patients on dialysis. Methods and ResultsPercutane...

Elderly patients who undergo coronary artery stenting have significantly higher rates of procedural complications and worse six month outcomes than younger patients, especially those who present with combined unstable angina, history of MI, EF < 50%, multivessel disease and complex lesions. Overall survival in the elderly population at 12 months postcoronary artery stenting was 91% and event-free survival was 54%.