The Journal of invasive cardiology
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Review Case Reports
Very late bare-metal stent thrombosis. A case report and review of the literature.
Stent thrombosis is a catastrophic event characterized by the acute thrombotic occlusion of a previously-stented segment of a coronary artery. It usually presents as an ST-segment elevation myocardial infarction and/or death, and most commonly occurs within the first several weeks after stent placement. ⋯ While very late stent thrombosis (VLST), occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 717 days after implantation.
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Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) achieves brisk coronary flow in > 90% of patients, but myocardial reperfusion (reperfusion at the tissue level) is often suboptimal, as evidenced by persistent ST-segment elevation and abnormal myocardial blush. Patients with suboptimal myocardial reperfusion have limited myocardial salvage and increased mortality. Distal micro-embolization may contribute to poor myocardial reperfusion, and this has stimulated great interest in the use of adjunctive thrombectomy with primary PCI in an attempt to prevent distal micro-embolization and improve outcomes. ⋯ The results of these trials have been conflicting and the totality of evidence does not support the routine use of thrombectomy for removal of thrombus in patients with STEMI treated with primary PCI. In patients with large thrombus burden, distal macroembolization is common and is associated with poor outcomes. Adjunctive thrombectomy can effectively remove thrombus, and it seems appropriate to perform adjunctive thrombectomy prior to primary PCI in patients with large thrombus burden.
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Patients with cardiac arrest have been excluded from most randomized trials on percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). ⋯ Combining immediate initiation of resuscitation maneuvers and primary PCI yields a very good clinical outcome in patients with AMI suffering from cardiac arrest.
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Randomized Controlled Trial
Nitroglycerin, nitroprusside, or both, in preventing radial artery spasm during transradial artery catheterization.
Radial artery spasm remains a major complication of transradial coronary interventions. The aim of this study was to compare the efficacy of three different intra-arterial vasodilating cocktails in reducing the incidence of radial artery spasm in patients undergoing transradial coronary angiography. The secondary goal was to assess the predictors of arterial spasm in this large group of patients. ⋯ In this prospective, randomized trial, the addition of a direct nitric oxide donor to nitroglycerin in an antispastic cocktail did not reduce the risk of spasm, and the use of nitroglycerin was found to be as effective as nitroprusside. Also, morphometric and mechanical factors play a significant role in predicting the occurrence of radial spasm. The sex of the patient, presence of diabetes, body surface area and smoking history appeared to play no role in predicting the occurrence of radial spasm.