Stent implantation in coronary stenosis has revolutionized the treatment of coronary artery disease. The introduction of antirestenotic drug coatings further improved their efficacy in reducing ...target vessel revascularizations. With increasing use of drug-eluting stents (DES), stent thrombosis (ST) rose as potentially fatal major complication. Initially, the incidence of ST late after stent implantation seemed to be similar for DES and bare metal stents until several studies proved otherwise in first-generation DES. Since then, the design and components of DES have been changed and new polymers, drugs and different combinations of platelet inhibitors have been introduced to further improve the safety of DES. In this review, the authors focus on the relationship between DES, lesion anatomy, implantation technique and pharmacology to avoid the occurrence of ST. Furthermore, the relationship between dual antiplatelet therapy, bleeding rate and its significant impact on patient outcome is discussed. Finally, some promising future concepts are highlighted.
This case report describes a quick and safe method to successfully retrieve an undeflatable angioplasty balloon via the transradial access site. The article also presents potential mechanisms of ...contrast media entrapment and bench tests of guidewire-assisted balloon puncture. After successful stent implantation in the proximal right coronary artery in a 74-year-old female patient referred for acute coronary syndrome, the balloon catheter became undeflatable for an unknown reason. Several attempts to burst the balloon in the guide catheter and the aorta failed. After a pullback into the radial artery, the still inflated balloon became stuck again and was unable to be retrieved through the sheath. Finally, transcutaneous puncture and aspiration of contrast media with a 23 gauge syringe needle through the skin in the right forearm allowed deflation and successful removal the balloon.
Hypoplastic coronary artery disease is a rare condition that may lead to myocardial infarction and sudden death. Here we describe for the first time an isolated hypoplasia of the left circumflex ...artery (LCX). An otherwise healthy and athletically active 16-year-old boy was admitted to the intensive care unit (ICU) after out-of-hospital cardiac arrest. He died 12 hours after the initial event. Autopsy revealed an isolated hypoplastic LCX and acute haemorrhagic infarction in the posterolateral myocardium. The existence of isolated hypoplasia of the LCX challenges our understanding of coronary artery development. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1558483061962648.
Abstract Objectives This randomized trial investigated to what extent loading with prasugrel can provide a more rapid peri-interventional antiplatelet effect than clopidogrel 600 mg. Background ...Effective platelet inhibition at the start of a percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. With clopidogrel administered immediately before a PCI, effective platelet inhibition is delayed by 2 h. Prasugrel has the potential of shortening this period. Methods We randomly assigned 300 P2Y12 receptor blocker–naive patients undergoing an elective PCI to loading with clopidogrel 600 mg, prasugrel 30 mg, or prasugrel 60 mg immediately before the PCI. Platelet function was assessed serially by impedance aggregometry. The primary endpoint was the proportion of patients with high on-treatment platelet reactivity at 60 min after loading defined as ≥468 aggregation units × minute (Multiplate Analyzer, Roche Diagnostics, Mannheim, Germany). Results The 3 groups were well balanced with respect to clinical and angiographic characteristics. At 60 min, 33% of the patients assigned to prasugrel 60 mg, 37% of patients assigned to prasugrel 30 mg, but 55% of those assigned to clopidogrel had high on-treatment platelet reactivity (p < 0.001). At any time point starting from 30 min, prasugrel 60 mg achieved significantly lower platelet reactivity than clopidogrel. Platelet reactivity at 60 min after prasugrel was not significantly different from that at 120 min after clopidogrel (p = 0.18). Prasugrel 30 mg had an intermediate effect. The 30-day incidence of bleeding events was not different among the 3 groups. Conclusions From 30 min onward, prasugrel 60 mg achieved a stronger platelet inhibition than clopidogrel loading in stable patients undergoing a PCI. Compared with clopidogrel, prasugrel 60 mg was associated with a twice as fast onset of platelet inhibition. (Impact of Extent of Clopidogrel-Induced Platelet Inhibition during Elective Stent Implantation on Clinical Event Rate—Advanced Loading Strategies ExcelsiorLOAD; DRKS00006102 )
Real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography in assessing left atrial (LA) parameters, but to date algorithms developed for the left ventricle ...were applied due to a lack of dedicated LA software. In addition, no data are available on RT3DE assessment of active atrial contraction. The aim of this study was to validate a novel RT3DE analysis tool specifically dedicated to evaluate the LA. Cardiac magnetic resonance imaging (MRI) served as standard of reference. Fifty-five patients scheduled for pulmonary vein isolation underwent cardiac MRI and RT3DE. On ultrasound image datasets, a dynamic polyhedron model of the LA was generated from which LA maximum and minimum volumes (LA
max
and LA
min
), passive atrial emptying fraction (LAEF), and active atrial ejection fraction (LAEF
true
) were derived and compared to values obtained from cardiac MRI. High intraclass correlations between RT3DE and MRI were found for LA
max
(r = 0.94,
p
< 0.001), LA
min
(r = 0.95,
p
< 0.001), LAEF (r = 0.92,
p
< 0.001), and LAEF
true
(r = 0.87,
p
< 0.001). Similarly, Bland–Altman analysis revealed narrow limits of agreement for LA
max
(−28.6 to 14.1 ml), LA
min
(−26.8 to 12.4 ml), LAEF (−11.2 to 14.9 %), and LAEF
true
(−10.6 to 6.8 %). LA
max
, LA
min
and LAEF
true
were measured significantly (
p
< 0.05) lower by RT3DE (111 ± 38 ml vs. 118 ± 39 ml, 73 ± 38 ml vs. 80 ± 41 ml, and 23 ± 14 % vs. 27 ± 14 %, respectively). Interobserver and intraobserver RT3DE measurements correlated closely. RT3DE using a novel dedicated software tool is valid, accurate and reproducible for assessing LA dimensional and functional parameters. This study corroborates previous reports and extends its validity to the assessment of active LA contraction.
Electrical storm after conus branch occlusion Riede, Florian N.; Gutmann, Marc; Meier, Yves ...
IHJ cardiovascular case reports,
December 2018, 2018-12-00, 2018-12-01, Letnik:
2
Journal Article
Recenzirano
Odprti dostop
Ventricular arrhythmias can occur in the course of myocardial infarction due to ischemia of substantial parts of the myocardium and often reside after the occluded vessel has been reopened. We hereby ...report a case of a 73-year-old male, who presented with acute coronary syndrome and was treated for a subtotal stenosis of the ostial right coronary artery. Subsequently, he developed Brugada syndrome type ECG changes and electrical storm, which was later explained by occlusion of the conus branch. After re-opening of the occluded vessel no further arrhythmias were recorded.
Isolated infarctions of the subepicardial myocardium without changes in subendocardium are extremely rare. We present an autoptic case with an acute subepicardial infarction of the right- and ...left-ventricular myocardium.
A 53-year-old male was admitted to hospital with acute upper abdominal pain. Clinical examination revealed an acute infero-lateral myocardial infarction. The patient succumbed to acute heart failure a few hours later.
Autopsy revealed numerous pulmonary abscesses due to suppurative lobular pneumonia with consecutive pericardial effusion. Furthermore, we diagnosed an acute myocardial infarct encompassing the entire right and left ventricles but limited to the subepicardial myocardium only. Microscopically, we observed fibrin microemboli in the subepicardial microvessels.
The existence of an isolated subepicardial myocardial infarct challenges our understanding of myocardial perfusion.
In percutaneous coronary intervention for de-novo coronary bifurcation lesions, the optimal technique for provisional side-branch stenting is still a matter of debate. We tested whether in this ...setting culotte stenting reduces the incidence of restenosis as compared with T-and-protrusion (TAP) stenting.
This trial included 300 patients with a coronary bifurcation lesion requiring a side-branch stent. Patients were randomly assigned to culotte stenting or TAP stenting using drug-eluting stents in a 1:1 fashion. Primary endpoint was maximal per cent diameter stenosis of the bifurcation lesion at 9-month angiographic follow-up. As clinical endpoints we assessed target lesion re-intervention (TLR) and target lesion failure (composite of cardiac death, target vessel myocardial infarction, and TLR).Angiographic follow-up was available in 91% of the patients. After culotte stenting, the maximum per cent diameter stenosis in the treated bifurcation lesion was 21 ± 20% as compared with 27 ± 25% after TAP stenting (P = 0.038). The respective corresponding binary restenosis rates were 6.5 and 17% (P = 0.006). The 1-year incidence of TLR was 6.0% after culotte stenting vs. 12.0% after T-stenting (P = 0.069). Target lesion failure occurred in 6.7% of the culotte group and in 12.0% of the TAP group (P = 0.11). Only one patient of the culotte group incurred a definite stent thrombosis during 1-year follow-up.
Compared with the TAP stenting, culotte stenting was associated with a significantly lower incidence of angiographic restenosis.
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