Multivessel Coronary Angioplasty with Drug Eluting Stents in a Chronically Hemodialyzed Diabetic Patient with Impaired Left Ventricular Systolic Function

We present a case of staged multivessel percutaneous coronary intervention (PCI) with drug-eluting-stents (DES) in a diabetic patient with three-vessel coronary heart disease (CHD), dialysis-dependent chronic renal failure and impaired left ventricular (LV) systolic function. The optimal method of coronary revascularization in dialysis patients is controversial. Surgical treatment (CABG) is a high-risk procedure. CABG in the pre- DES era was associated with a better long-term prognosis, but at the cost of higher in-hospital mortality. PCI using DES may be a feasible therapeutic alternative.The revascularization strategy is reviewed

Επιπλεγμένη Αγγειοπλαστική Διάσωσης (Rescue PCI) σε 38χρονο Ασθενή

Περιγράφεται η περίπτωση 38χρονου ασθενούς με θρομβολυμένο οξύ πρόσθιο έμφραγμα που επεπλάκη από μετεφραγματική στηθάγχη, καρδιακή ανεπάρκεια και καρδιογενές shock και οδηγήθηκε σε επείγουσα στεφανιογραφία που κατέδειξε νόσο στελέχους και 3 αγγείων. Ο ασθενής αντιμετωπίστηκε με αγγειοπλασική διασώσεως (rescue) και stenting με λίαν επιπλεγμένη πορεία, οι φάσεις της οποίας αναλύονται λεπτομερώς με τελική ωστόσο ικανοποιητική έκβαση

Severe accordion effect: Myocardial ischemia due to wire complication during percutaneous coronary intervention: A case report

A mechanical alteration during manoeuvring of stiff guidewires in tortuous coronary arteries frequently induces vessel wall shortening and coronary psedostenosis, referred as accordion phenomenon. Subtraction of the guidewires normally leads to the entire resolution of the lesions. A case of this transient angiographic finding, during percutaneous coronary intervention in a tortuous right coronary artery, which resulted in a flow limiting effect and myocardial ischemia, is described in the present report. Differential diagnosis from potential procedure complications and interventional methodology issues are discussed, while similar reports are reviewed

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

BACKROUND: Primary percutaneous coronary intervention (PCI) has been shown to be a better reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) compared with thrombolysis, particularly when applied early. The objective of the present study was to report our experience from treating patients presenting to the emergency room of our hospital with STEMI with primary PCI. PATIENTS AND METHODS: The population of the study included 100 patients who presented to our hospital with STEMI and underwent primary PCI over a 12-month period. Patients’ clinical and angiographic data were retrospectively collected and patients were followed up for 9 months. Technical details of the primary PCI, including stent implantation, and use of drug eluting stents, thrombus aspiration catheter, or platelet glycoprotein IIb/ΙΙΙa inhibitors were recorded and correlated to clinical and angiographic patient data. RESULTS: Of 196 patients who presented o the emergency room with STEMI during the study period, 100 (51%) patients (85 men and 15 women) underwent primary PCI. PCI was successful with TIMI 3 flow of the infarct-related coronary artery in 79 (79%) patients. Six (6%) patients died during hospitalization and another 4 (4.3%) patients died during the 9-month follow up period. Twenty one (22%) patients required rehospitalization for acute coronary syndrome, of whom 17 needed a repeat PCI and 4 patients were submitted to coronary artery bypass grafting. Left ventricular ejection fraction (LVEF) was <50% in 54 (54%) patients. In 52 patients primary PCI was performed in less than 4 hours from onset of symptoms. In his cohort, 19 patients were thrombolyzed before arriving to the catheterization laboratory. Antithrombotic therapy with platelet glycoprotein IIb/IIIa inhibitors was used in 48 (48%) patients. Univariate analysis showed that the odds of achieving TIMI 3 flow were higher after using IIb/ΙΙΙa inhibitors (odds ratio-OR 6.4) or if the LVEF ≥50% (vs LVEF < 50%) at the beginning of the PCI (OR 6.4). If the time from the onset of symptoms to PCI was >4 hours, the odds of achieving TIMI 3 flow were reduced by 23.4% compared to time from symptoms to PCI <4 hours. The presence of TIMI 3 flow of the infarct-related artery reduced the odds of death by 10.2% compared to the absence of TIMI 3 flow of the infarct-related coronary artery. CONCLUSION: Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of LVEF >50% and the importance of achieving TIMI 3 flow in the IRA at the end of the procedure

Endovascular Treatment of Aneurysm With Side Branches - A Simple Method. Myth or Reality?

PURPOSE: The aim of this study is to present performance data on the use of the multilayer stent which is a 3-dimensional (3D) braided mesh made of interconnected layers, particularly in patients with side branches within the aneurysm. METHODS:  A study protocol was designed to examine the safety and efficacy of the multilayer stent in patients with aneurysms in different target vessels. Between December 2006 and November 2009, 19 patients were enrolled in the study. Four patients had a renal aneurysm (1 male / 3 females) (mean diameter: 18 mm), while the other 15 patients (all males) had iliac artery (n=12, mean diameter: 25 mm),  popliteal artery (n=1, diameter: 55 mm), thoracic aorta (n=1, diameter: 57mm) and abdominal aorta (n=1, diameter: 97.3 mm) aneurysms. RESULTS: The multilayer stent was successfully deployed in all patients (100% technical success); Mean follow-up for the peripheral aneurysms was 28 months (range 12 to 36) and for the aortic aneurysms was 3 months. The occlusion rate of the aneurysm at the peripheral arteries was 100% and all the side branches remained patent. For the thoracic and the abdominal aneurysms, the 3 months computed tomography angiography (CTA) showed patent artery side branches and reduced blood flow inside the sac. CONCLUSION: The multilayer stent seems to be efficient with regard to the side branches which remain patent and the aneurysm is excluded. The question remains about the time needed to achieve the exclusion of the aneurysm in large arteries such as the thoracic and abdominal aorta; we believe this is related to the number and size of the branches within the aneurysm as well as the size of the target vessel itself. A larger multi center study is needed to confirm the suitability of the multilayer stent for the large thoracic, abdominal and thoracoabdominal aneurysms

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

We report our experience from treating a large number of patients who presented to the Emergency Department of our Hospital with ST-elevation acute myocardial infarction (AMI) with primary percutaneous coronary intervention (PCI). Of the 196 patients who presented with ST elevation AMI over a period of 12 months, 100 (51%) patients underwent primary PCI. Clinical and angiographic data were collected and patients were followed up for 9 months. Technical details of the primary PCI, including use of balloon, use of thrombus aspiration catheter, stent implantation, use of drug eluting stents, and use of GP IIb/IIIa inhibitors were recorded and correlated to clinical and angiographic patient data. Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of left ventricular ejection fraction >50% and the importance of achieving TIMI 3 flow in the AMI related artery at the end of the procedure