Thrombus aspiration in acute myocardial infarction: Rationale and indication

Reperfusion of myocardial tissue is the main goal of primary percutaneous coronary intervention (PPCI) with stent implantation in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Although PPCI has contributed to a dramatic reduction in cardiovascular mortality over three decades, normal myocardial perfusion is not restored in approximately one-third of these patients. Several mechanisms may contribute to myocardial reperfusion failure, in particular distal embolization of the thrombus and plaque fragments. In fact, this is a possible complication during PPCI, resulting in microvascular obstruction and no-reflow phenomenon. The presence of a visible thrombus at the time of PPCI in patients with STEMI is associated with poor procedural and clinical outcomes. Aspiration thrombectomy during PPCI has been proposed to prevent embolization in order to improve these outcomes. In fact, the most recent guidelines suggest the routine use of manual aspiration thrombectomy during PPCI (class IIa) to reduce the risk of distal embolization. Even though numerous international studies have been reported, there are conflicting results on the clinical impact of aspiration thrombectomy during PPCI. In particular, data on long-term clinical outcomes are still inconsistent. In this review, we have carefully analyzed literature data on thrombectomy during PPCI, taking into account the most recent studies and meta-analyses

Multiple and Contemporary Coronary Thrombosis inspite of Low Platelet Function Response

We are reporting a clinical case of a 78-year-old male who had oppressive chest pain at rest, which regressed with the intake of sublingual nitrates. Coronary angiography showed a chronic total occlusion (CTO) of the left anterior descending (LAD) artery, a normal circumflex, a hypoplasic right coronary artery and a Cardiac Magnetic Resonance showing vital tissue in anterior wall. During the procedure of CTO-PCI on LAD, patient developed multiple and contemporary coronary thrombosis in spite of low platelet reactivity, which was assessed by using Multiplate. A manual thrombectomy was performed with a good final result only after drug eluting stents (DES) implantation

CoreValve repositioning complicated by entrapment of snare in the valve delivery anchor

We report on the treatment of a patient, with severe peri-prosthetic regurgitation, following CoreValve implantation too low into the left ventricle outflow tract, adjusted by 'snaring' prosthesis. This bail-out manoeuvre allows the appropriate positioning of the prosthesis but was complicated by the entrapment of the goose-neck loop in the valve delivery anchor and was solved successfully with a second different device

Five Years on Dual-Antiplatelet Therapy DES Thrombosis After Clopidogrel Withdrawal

Drug-eluting stents (DES) have a moderately higher incidence of stent thrombosis compared to bare metal stents (BMS) and very late DES thrombosis has been frequently described. We report a case of a 66 year-old male who experienced very late stent thrombosis at 5 years after paclitaxel-eluting stent (PES) implantation and 3 days after clopidogrel withdrawal. Intravascular ultrasound (IVUS) performed during the index procedure showed that the previously implanted PES was undersized. Since the patient could not take clopidogrel, we treated him with only a noncompliant balloon (3.0 x 15 mm) with optimal expansion as confirmed by IVUS. This case report describes a patient who continued clopidogrel treatment for 5 years and was probably protected from a procedural failure. During the current hospitalization, the patient was found to be a responder to clopidogrel after a platelet function assessment with Multiplate (Dynabyte Informationssysteme GmbH, Munich, Germany)

The statin therapy to prevent atrial fibrillation after cardiac surgery: Shakespearean dilemma

Surgical and perioperative care are much improved in the last years but postoperative complications after cardiac surgery remain frequent, which are directly involved to increase the mortality, morbidity, and costs (1). Atrial arrhythmias and atrial fibrillation (AF) in particular are well-known complications after cardiac surgery with a reported incidence between 10% and 60% (2). Postoperative atrial arrhythmias extend the hospitalization, decreasing the hemodynamic condition and increasing the risk of stroke and mortality (3). The incidence is higher in patients undergoing valve surgery than in patients undergoing coronary artery bypass surgery (CABG) (4). Despite lower, post-operative atrial arrhythmias also occur after non-cardiac surgery (from 0.3% to 29%) (5,6), especially after oesophagectomy (7), lung surgery (6), and large abdominal surge

Prasugrel or Ticagrelor in ST-Segment-Elevation Myocardial Infarction Patients with Diabetes Mellitus

Prasugrel or Ticagrelor in ST-Segment–Elevation Myocardial Infarction Patients With Diabetes Mellitu

Effect of adenosine intracoronary bolus on myonecrosis occurrence in elective PCI (RACE trial)

[No abstract available