Editorial Note

Article Outline

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Over the last 6 months, we have experienced a siege on percutaneous coronary intervention (PCI). It began with a cluster of publications on drug-eluting stent late stent thrombosis and picked up momentum with the publication of the COURAGE study in March 2007. The media played a significant role in emphasizing negative press related to PCI, and the outcome, seen mainly in the United States, is a reduction in the number of patients referred for PCI and for cardiac catheterization. There are many options left open as a result of this state of confusion. Is the reduction in the volume of intervention a natural correction related to better medical management and less restenosis with drug-eluting stents? Or is it the fear factor that holds patients to their medical therapy and unwillingness to undergo percutaneous procedures? The medical community is extremely sensitive to any piece of information generated from ongoing studies, yet we must be cautious. Many of these studies are underpowered or have not been completed, and even meta-analyses carry with them significant limitations. Cardiovascular Revascularization Medicine is focused on these issues and welcomes all contributions for a special issue devoted to these topics and the current state of the field.

Five clinical original articles are presented in this issue. In the first, by Niccoli et al., the authors assessed the predictive value of preprocedural C-reactive protein serum levels on recurrence of cardiac events after directional coronary atherectomy followed by bare metal stent implantation. Next, McCollough et al. evaluated the degree of residual angina on the outcomes of enhanced external counterpulsation therapy for chronic stable angina. In their study, Ille et al. investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence after cardiac surgery. Ruef et al. then report on 200 patients with diffuse in-stent restenosis treated with intravascular brachytherapy who were retrospectively followed over 4 years. In the final clinical original article, Lopez-Minguez et al. aimed to evaluate whether abciximab could be more beneficial in different patient subgroups and whether its use could provide additional benefits to those afforded by drug-eluting stents in these patients.

In our sole biology original article, Ayral et al. determined the effect of prolonged treatment with clopidogrel on C-reactive protein concentrations and blood thrombogenicity after percutaneous transluminal coronary angioplasty followed by intracoronary brachytherapy in the porcine model. In their cell therapy submission, Jensen et al. aimed to evaluate the effects on human stem cells in vitro and in vivo of an extract from the edible cyanobacterium Aphanizomenon flos-aquae enriched for a novel ligand for human CD62L (l-selectin).

In the first of four case reports, Carrafiello et al. describe the use of a technique involving the Amplatzer Vascular Plug to perform an endovascular ligature to exclude splenic artery aneurysm of the middle tract of the splenic artery. Matsuo et al. then present a case that demonstrates the utility of preprocedure multidetector-row computed tomography scanning to define anatomy prior to atrial fibrillation ablation procedures. Suh et al. present a patient with unprotected left main stenosis in whom cardiac magnetic resonance imaging assisted in the decision to perform PCI over coronary artery bypass surgery. Lastly, Cardaioli et al. suggest that endovascular techniques may offer a reliable and effective answer to extended dissection, helping to decrease the risk of neurological or visceral and reducing the operative risk of further complete surgical or endovascular aortic repair.

Our review article, by Bayard et al., presents a review on the current results and techniques of the most commonly used devices as well as on new developments and approaches to catheter-based stroke prevention. The image of the issue, presented by Rigatelli et al., shows digital subtraction angiography of the common carotid artery and the result of stent graft repair.

We hope that you find this issue diverse in content and interesting to read. Again, we encourage you, our readers, to share your thoughts on what needs to be done to bring clarity to the burning issues related to PCI as we celebrate the 30-year anniversary of the first angioplasty performed by Andreas Gruntzig in September 1977.