Technical considerations when intervening with coronary device catheters in the vicinity of previously deployed stents

As stent use increases, interventional cardiologists are increasingly faced with patients that require procedures in the vicinity of previously deployed stents. We present two cases of side-branch interventions in the vicinity of previously deployed stents where devices were trapped by the stent. In each case, traction on the device resulted in stent dislodgment. The stents were successfully extracted and replaced without complications.

Modern management of prosthetic valve anticoagulation

Prosthetic heart valves have been effectively used for many years. Nonetheless, they are associated with risks of thrombosis and thromboembolic events, as well as anticoagulation-induced bleeding. Substantial changes in anticoagulation measurement and dosing have occurred during the past several years. In this review, the rationale for anticoagulation in patients with prosthetic heart valves, the changes in monitoring and dosing, and the comparison of relevant anticoagulation trials are discussed. On the basis of the existing data, new recommendations regarding lower anticoagulation levels are offered, utilizing a single value goal rather than the traditional therapeutic range. Perioperative management of anticoagulation is discussed in light of the available literature, and major drug interactions are reviewed.

Paraneoplastic cholestasis and hypercoagulability associated with medullary thyroid carcinoma. Resolution with tumor debulking

The authors report a 69-year-old woman with a hypercoagulable state manifesting as superior sagittal sinus thrombosis, thrombocytosis, right lower extremity deep venous thrombosis, and subsequent pulmonary embolus. The liver enzyme values were elevated in a cholestatic pattern. Carcinoembryonic antigen level was markedly elevated. Evaluation revealed that her longstanding "goiter" had slowly enlarged during the past 6 years. The serum calcitonin level was markedly elevated. Subsequent biopsy revealed medullary thyroid carcinoma. Surgical debulking of the tumor and lymph nodes resulted in substantial reduction of the calcitonin and carcinoembryonic antigen levels in a matter of days. Long-term follow-up revealed normalization of cholestasis and resolution of the hypercoagulable state. Review of the literature revealed no previously reported cholestasis or hypercoagulable state associated with medullary thyroid carcinoma. The literature on paraneoplastic cholestasis, carcinoembryonic antigen production, and hypercoagulable states is reviewed.