Simultaneous subacute thrombosis of bare metal coronary stents in two different arteries early after clopidogrel cessation

Coronary stent thrombosis is a rare event leading to ST segment elevation myocardial infarction and death. Although early thrombosis of drug-eluting and bare metal stents is relatively frequent, simultaneous thrombosis of bare metal coronary stents has rarely been reported. Here, we present a case of simultaneous subacute thrombosis of two bare metal stents in different coronary arteries early after clopidogrel cessation

Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention

Coronary artery perforations are life-threatening complications with a poor outcome. Historically, if the perforation was not controlled using conservative methods such as prolonged balloon inflation and protamine administration, emergency cardiac surgery has been performed. However, several percutaneous methods including covered stents and embolization materials have emerged as therapeutic options to manage coronary perforations. We report a case of right coronary artery perforation after high pressure stent post-dilatation that was successfully sealed with a polytetrafluoroethylene-covered stent

The use of Amplatzer Vascular Plug® to treat coronary steal due to unligated thoracic side branch of left internal mammary artery: Four year follow-up results

Left internal mammary artery (LIMA) is the most commonly used graft during coronary bypass surgery. LIMA side branches are clipped during surgery in order to prevent coronary steal. In cases of patent LIMA side branches, there are differingapproaches. Herein, we report a case with patent thoracic side branch of LIMA graft, occlusion of this side branch by Amplatzer Vascular Plug because of documented myocardial ischemia, and long term follow-up results. (Cardiol J 2012; 19, 2: 197–200

Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography

Background: Total white blood cell (WBC) count has been consistently shown to be an independent risk factor and predictor for future cardiovascular outcomes, regardless of disease status in coronary artery disease (CAD). The purpose of this study is to evaluate the relationship between total WBC count and the presence, severity and extent of coronary atherosclerosis detected in subjects undergoing multislice computed tomographic (MSCT) coronary angiography for suspected CAD. Methods: A total of 817 patients were enrolled in this cross-sectional study. Non-significant coronary plaque was defined as lesions causing &#163; 50% luminal narrowing, and significant coronary plaque was defined as lesions causing > 50% luminal narrowing. For each segment, coronary atherosclerotic lesions were categorized as none, calcified, non-calcified and mixed. All images were interpreted immediately after scanning by an experienced radiologist. Results: An association between hypertension, diabetes mellitus, age, gender, hyperlipidemia, smoking, total WBC counts and coronary atherosclerosis was found when patients were grouped into two categories according to the presence of coronary atherosclerosis (p < 0.05). Although plaque morphology was not associated with total WBC counts, the extent of coronary atherosclerosis was increased with higher total WBC quartiles (p = 0.006). Patients with critical luminal stenosis had higher levels of total WBC counts when compared to patients with non-critical luminal narrowing (7,982 &#177; 2,287 vs 7,184 &#177; 1,944, p < 0.05). Conclusions: Our study demonstrated that total WBC counts play an important role in inflammation and are associated with the presence, severity and extent of coronary atherosclerosis detected by MSCT. Further studies are needed to assess the true impact of WBC counts on coronary atherosclerosis, and to promote its use in predicting CAD. (Cardiol J 2011; 18, 4: 371&#8211;377

Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study

Background: Secondary prevention plays an important role after acute coronary event due to high risk of adverse events in elderly. In present study we aimed to evaluate the lifestyle, management of risk factors and medical treatment for secondary protection in elderly patients with known coronary heart disease (CHD). Methods: ELDERTURK is a non-interventional, multi-centered, observational study, which included total of 5694 elderly patients ( &gt; 65 years) from 50 centers in Turkey. In this study elderly patients from the ELDERTURK population with known CHD were evaluated for cardiovascular risk factors, comor- bidities and medication usage. Results: A total of 2976 (52.3% of study) out of 5694 patients included in the ELDERTURK study were evaluated. All had known CHD with a mean age of 73.4 ± 6.2 years and 60.3% were male. 13.0% of patients were smokers, 42.4% were overweight and 21.1% were obese. Only 23.6% of patients reported to do regular exercise, 73.4% had history of hypertension, 47.4% had dyslipidemia and 33.9% had diabetes mellitus. The rate of patients with systolic blood pressure &gt; 140 mmHg were 31.1% and only 13.9% of patients had a recommended ≤ 70 mg/dL level of low-density lipoprotein cholesterol. Anti- platelet, statin, beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage was limited to 27.3%. Conclusions: The ELDERTURK study shows that many patients with CHD have a high prevalence of modifiable risk factors and unhealthy lifestyle. Apart from this, many patients are not receiving thera- peutic intervention and as a consequence most were not achieving the recommended goals.   

CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices

PURPOSE:To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD).METHODS:A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed.RESULTS:The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis.CONCLUSION:Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events

Long-term Outcome of Pulmonary Vein Isolation Versus Amiodarone Therapy in Patients with Coexistent Persistent AF and Congestive Heart Failure

Although pharmacological rhythm control of AF in patients with heart failure with reduced ejection fraction (HFrEF) does not seem to provide any benefit over rate control, catheter ablation of AF has been shown to improve clinical outcomes. These results can be explained with higher success rates of catheter ablation in restoring and maintaining sinus rhythm compared with antiarrhythmic drugs. In addition, pharmacotherapy is not void of side-effects, which are thought to offset its potential antiarrhythmic benefits. Therefore, efforts should be made towards optimisation of ablation techniques for AF in patients with HFrEF