Left Main Coronary Artery Bifurcation Thrombus Interventionally Removed

A 43-year-old male heavy smoker presented with acute inferolateral myocardial infarction. Coronary angiography showed a thrombus mounted upon the carina of the left main coronary artery (LMCA) bifurcation, protruding into the origin of the left anterior descending (LAD) coronary artery and completely occluding the left circumflex (LCX). There followed immediate thromboaspiration of the LAD thrombus. The LCX remained completely obliterated. A glycoprotein IIb/IIIa inhibitor was given for 48 hours and the patient received dual antiplateled treatment. On the eighth day, a repeat coronary angiogram was obtained, which showed patent LMCA and LAD while the LCX was now visible and patent with a TIMI III flow and no sign of thrombus

A Unique Right Coronary Artery Intra-coronary Collateral Pathway

In the coronary angiogram of a 73-year-old man with angina pectoris, we noted the right coronary artery (RCA) proximally occluded with an atrial intra-coronary collateral pathway emerging from a proximal sinus node artery (SNA) and ending to a distal “right posterior” SNA (RPSNA), which was retrogradely supplying the peripheral RCA; such right posterior sinus node artery was first described, coined and reported back in 2000

Coronary “Collateralization” or “De-collateralization” by Percutaneous Coronary Intervention in the Collateral Flow Supplying or Receiving Vessel

Images of coronary angiography are being presented of two patients undergoing percutaneous coronary intervention (PCI). In the first patient with chronic total vessel occlusion, who also had a significant stenosis of the contralateral artery, there were no visible collaterals, which became fully functional and visible right after the successful PCI of the contralateral lesion (collateralization by PCI). In the second patient with acute myocardial infarction undergoing primary PCI of a total vessel occlusion, there was good collateral supply (provided by the contralateral vessel), which vanished upon restoration of anterograde flow to the totally occluded artery (de-collateralization by PCI)

Tako Tsubo Cardiomyopathy with Right Ventricular Involvement

A 68–year–old woman, 4 hours after bronchoscopy, developed symptoms and ECG signs of inferolateral acute myocardial infarction. Emergency coronary angiography showed normal coronary arteries, but LV angiography revealed apical ballooning with apical akinesis diagnostic of Tako-tsubo cardiomyopathy. One day later cardiac MRI additionally disclosed right ventricular apical involvement, which has been reported in only very few cases in the literature associated with worse prognosis. Fortunately, our patient had an uneventful course and complete recovery

Primary Congenital Coronary Artery Anomalies: An Angiographic Study in Greece

Abstract Background: Primary congenital coronary anomalies are anatomical variations of the origin, course and termination of coronary arteries, which are not associated with complex congenital heart disease. In Greece, apart from some case reports, there are no published data. Thus, the aim of this study was to assess the prevalence of the different forms of primary coronary artery anomalies in a Greek adult population. Methods: 5051 coronary arteriographies obtained from January 2008 to December 2010 were retrospectively analyzed. Coronary anomalies were classified according to the criteria proposed by Angelini and coworkers as anomalies of origin and course, anomalies of intrinsic coronary anatomy, and anomalies of termination. Results: 123 variations of coronary artery anatomy (incidence 2.44%) were identified. Of these, 76 (61.8%) patients had anomalous origin and course, 25 (20.3%) patients had ectasias, 14 (11.4%) patients had myocardial bridging, and 8 (6.5%) patients had small coronary fistulas. The most common anomalies observed were the separate origin of the left anterior descending (LAD) and left circumflex (LCx) coronary arteries, the ectopic right coronary artery (RCA) and the anomalous LCx from the opposite sinus. Conclusions: The incidence of primary congenital anomalies in Greece is similar to that reported in other populations. Congenital coronary anomalies do not predispose to accelerated atherosclerosis of the anomalous vessel. Although the majority of coronary anomalies were not associated with symptoms and were detected incedentaly during coronary angiography, awareness of these anatomical variants is clinically important for the appropriate management of cardiac patients

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

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