Background: Percutaneous coronary intervention (PCI) in ostial coronary artery lesions has been technically difficult because it should be done with precise stent placement in ostium and absence of side branch compromise. The Szabo technique consists of side branch wiring through most proximal stent strut as well as main branch wiring through stent lumen. The side branch wire or anchor wire prevents stent advancement beyond ostial segment and makes possible the accurate stent implantation in ostium. The purpose of this study is to evaluate the feasibility and success rate of Szabo technique analysing technical, angiographic and IVUS(Intravascular Ultrasonography) findings success rate.Methods: We analysed retrospectively in our cath lab, 13 PCIs in 13 patients with a significant lesion at a coronary artery ostium which was treated percutaneously using Szabo technique. The procedure was defined as technically successful if there was neither stent loss nor second guide wire pull back during stent advancement. A successful procedure from angiographic point of view was defined as a precise stent implantation at ostium without side branch compromise. We defined also successful procedure from IVUS point of view consisting of accurate stent placement in ostium without proximal protrusion and without any stent uncovered area. Results: Of a total of 13 patients with 10 (76.9%) males, 46.2% had diabetes, 69.2% hypertension, 53.8% hypercholesterolemia and 23.1 % were smoker or former smoker. They aged from 37-81 years with a mean age of 63±11 years. In 11 (84.6%) patients 6F and in 2 (15.4%) patients 7F sheathless guiding catheter (Asahi Intecc Co; LTD. Japan) were used. The access was radial in 12 (92.3%) and femoral in 1 (7.7%). The culprit vessel was left anterior descending (LAD) in 9 (69.2%), right coronary artery (RCA) 2 (15.4%), circumflex- obtuse marginal (LCX-OM) 1(7.7%), and posterior descending (PDA) 1(7.7%). In 9 (69.2%) IVUS was performed through culprit vessel and in 2 (15.4%) IVUS was done also in side branch after stent implantation. In 11 (84.6%) the procedure was technically successful. Among technically successful patients all (100%) had angiographic success. IVUS examination of culprit vessel showed accurate stent placement in ostium 7 (77.8%) and slight stent proximal protrusion in 2 patients (22.2%).Conclusions: This study shows that Szabo technique is safe and feasible for PCI in ostial coronary artery lesions with a high angiographic success rate. In a high percentage of cases the accurate position of stent in ostium can be confirmed by IVUS.

Spontaneous coronary artery dissection (SCAD) is non-iatrogenic longitudinal separation of the coronary arterial walls, generating true and false lumens. Although it wasknownas a disease of the young females without cardiovascular risk factors, recent evidences have revealed that SCAD can also be seen in older patients having traditional risk factors for ather-osclerosis. In this report, we present a 50-year-old female patient with theSCADof left anterior descending artery (LAD) leading to anteriormyocardial infarction, ten days previously and persisting angina. She was successfully treated using intravascular ultrasound (IVUS) by stenting dissected segment. She has done well since then, and stent patency was demonstrated with coronary computed angiography (CTA) at the fifth-year follow up.

Background: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is one of the most challenging procedures in interventional cardiology. New techniques and devices have made possible to face these complex procedures. Intravascular ultrasound (IVUS) reveals special features and contributes greatly to procedural success.Method: We analysed retrospectively IVUS contribution and findings in 23 cases of a total 46 CTOs PCI from February 2009 to August 2010 in our cath lab. Both true and functional CTO were included in this study. The procedure was considered successful when a TIMI III flow was reached in the occluded vessel after stent implantation with a residual stenosis less than 30%. IVUS features and contribution in CTO-PCI were analysed.All data were introduced in SPSS version 15 (SPSS Inc. Chicago, Illinois, USA). Continuous variables were described by mean ± SD and categorical variables were expressed as percentage. A P<0.05 was considered statistically significant.Results: 46 PCIs in 34 patients were performed during 19 months in our centre. The procedure was successful in 28 cases (60.9%).. IVUS was performed in 23 (82.1%) of successful procedures. IVUS revealed calcium somewhere in 17 (73.9%). Despite wire angiographic verification in true lumen distally IVUS showed subintimal wire position in part of CTO segment in 6 (26.1%). In 22 (95.7%) of cases IVUS allowed both the wire position verification in true lumen and the vessel measurement before stent implantation. In 1 (4.3%) case a second wire was introduced into true lumen guided by IVUS after realising that the first wire was in false lumen. We could not find significant relation between calcium presence and subintimal wire penetration in CTO segment (p: 0.14) Conclusions: IVUS showed calcium in CTO segment in a high percentage of cases. It is not unusual to find wire penetration in subintimal space in part of CTO segment. IVUS has a key contribution in the step by step interpretation during PCIs of CTO. Wire position verification and more precise vessel measurement can be easily done by IVUS.

Acute coronary syndromes (ACS) and sudden cardiac death are the main causes of morbidity and mortality in the world.1 ACS are often the first manifestation of coronary artery disease, and the rupture of a coronary plaque is the main cause of ACS. Histopathological studies have revealed that the majority of thrombi result from plaque rupture.Grayscale intravascular ultrasonography (IVUS), a tomographic imaging tool, can visualize coronary atherosclerosis in vivo, elucidating plaque area, plaque distribution, lesion length, and coronary remodeling. IVUS has demonstrated the discrepancies between the extent of atherosclerosis seen by coronary angiography and the actual extent of atherosclerotic disease.2 Quantitative assessment of plaque composition has, however, not been possible with grayscale IVUS analysis, until now3.