The current DUS criteria for native renal arteries may overestimate the degree of angiographic ISR due to changes in compliance. We recommend that DUS laboratories make adjustments in PSV and RAR obtained by DUS when monitoring the patency of renal stents for ISR.

In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.

No abstract

Clinically evident and subclinical peri-procedural bleeding following interventional therapies are associated with adverse cardiovascular outcomes. The risk factors for clinically evident bleeding have been well described. Despite the welldocumented association of adverse outcomes for patients with a subclinical peri-procedural hemoglobin drop, the clinical predictors have not yet been defined. We identified 1176 consecutive patients with a subclinical drop in hemoglobin (fall of ≥ 1 g/dl in patients without clinical bleeding) following percutaneous coronary interventions (PCI) and peripheral vascular interventions (PVI). Multivariate logistic regression analysis was performed. A subclinical peri-procedural hemoglobin drop ≥ 1 g/dl was identified in 41% (400/972) of PCI and in 49% (213/435) of PVI. More than one access site predicted a higher risk of a subclinical drop in hemoglobin in both groups. A body mass index ≥ 30 predicted a lower risk of a subclinical drop in hemoglobin in both groups. For PCI, creatinine clearance < 60 ml/min was associated with a higher risk of a subclinical drop in hemoglobin. In conclusion, clinically silent peri-procedural hemoglobin fall ≥ 1 g/dl is common in patients undergoing both coronary and peripheral percutaneous intervention. Predictors identified in our study will need prospective validation.

Stress-induced cardiomyopathy, otherwise known as takotsubo cardiomyopathy, typically presents with chest pain and acute left ventricular failure with unobstructed coronary arteries. There is an increase in disease incidence as clinicians are becoming more aware of this clinical entity. An atypical variant exists where there is left ventricular dysfunction with apical sparing. Various precipitants have been described in the literature, however, there has not been any documented case following massive gastrointestinal bleeding. We report an atypical variant of takotsubo cardiomyopathy following a gastrointestinal bleed with review of the pathophysiologic mechanisms behind the disease process.