Novel Use of Dual Guiding Catheters Technique to Prevent Distal Embolization and Slow Flow during PCI of Coronary Stent Thrombosis

2021 ◽  
Author(s):  
Vijay Kumar Trehan ◽  
Gagan Jain ◽  
Puneet Gupta
Keyword(s):  
Stent Thrombosis ◽  
Coronary Intervention ◽  
Coronary Stent ◽  
Slow Flow ◽  
Thrombus Aspiration ◽  
Distal Embolization ◽  
Catheter Technique ◽  
Guide Catheter ◽  
Percutaneous Coronary ◽  
Angiographic Result

AbstractDespite having an incidence of 0.5 to 2%, stent thrombosis has an in-hospital mortality of 15% and myocardial infarction (MI) incidence of 67%. Even with the usage of thrombus aspiration devices and microvasculature vasodilators such as nitroprusside, verapamil, adenosine, and Gp2b/3a inhibitors, the angiographic result of percutaneous coronary intervention of coronary stent thrombosis remains frequently suboptimal due to distal embolization and subsequent slow flow. We describe a novel use of dual guide catheter technique, where one guide acts as conduit for thrombus aspiration catheter and the other for distal placement of balloon trap to prevent distal embolization while managing a case of coronary stent thrombosis to improve the angiographic outcome in this scenario.

scholarly journals Efficacy and safety of thrombus aspiration in ST-segment elevation myocardial infarction: an updated systematic review and meta-analysis of randomised clinical trials

2018 ◽  
Vol 8 (1) ◽  
pp. 24-38 ◽  
Author(s):  
Nevio Taglieri ◽  
Maria Letizia Bacchi Reggiani ◽  
Gabriele Ghetti ◽  
Francesco Saia ◽  
Miriam Compagnone ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Background: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. Methods: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. Results: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79–1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80–1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63–1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004–1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58–1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. Conclusions: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak.

scholarly journals Efficacy of thrombus aspiration during percutaneous coronary intervention for stent thrombosis

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 108-108
Author(s):  
S. Kubo ◽  
K. Kadota ◽  
S. Habara ◽  
T. Tada ◽  
H. Tanaka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
Percutaneous Coronary

scholarly journals Direct stenting in patients with ST-elevation myocardial infarction and hyperglycemia

2019 ◽  
Vol 23 (1S) ◽  
pp. 44
Author(s):  
I. S. Bessonov ◽  
V. A. Kuznetsov ◽  
E. A. Gorbatenko ◽  
I. P. Zyrianov ◽  
S. S. Sapozhnikov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Thrombus Aspiration ◽  
No Reflow ◽  
Direct Stenting ◽  
Percutaneous Coronary ◽  
St Elevation

<p><strong>Aim.</strong> To evaluate in-hospital outcomes of direct stenting compared with stenting after predilation in patients with ST-elevation myocardial infarction and hyperglycemia at admission.<br /><strong></strong></p><p><strong>Methods.</strong> Data were collected from hospital database, which includes information about all patients (n = 1 469) with ST-elevation myocardial infarction admitted to the coronary care unit and submitted to percutaneous coronary intervention. Plasma glucose was measured at hospital admission. Hyperglycemia was defined as plasma glucose of 7.77 mmol/L (140 mg/dL), regardless of the diabetic status. A total of 695 (46.3%) patients with hyperglycemia at admission were included in the analysis. Direct stenting (DS) was performed in 358 (51.5%) patients and 337 (48.5%) patients received stenting non-direct stenting. Among non-direct stenting group 292 (86.6%) patients received stenting after predilation, 19 (5.6%) patients received manual thrombus aspiration and 26 (7.7%) patients received stenting after combination of predilation and thrombus aspiration. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of angiographic no-reflow were analysed. The composite of in-hospital death, myocardial infarction, and stent thrombosis were defined as major adverse cardiac events (MACE). </p><p><strong>Results.</strong> The rate of angiographic success was higher in DS group (96.1% vs. 89%, р&lt;0,001). There were no difference in rates of stent thrombosis (1.1% vs. 0.9%, р = 0.764), repeat myocardial infarction (1.7% vs. 1.2%, р = 0,588), and access site complications (3.4% vs. 5.4%, р = 0.194) between groups. The rates death (3.9% vs. 9.5%, р = 0.003), MACE (5.3 vs. 11.3, р = 0.004), and no-reflow (2.2% vs. 11%, р&lt;0.001) were significantly lower in the direct stenting group. Following propensity score matching, each group contained 160 patients. The rate of no-reflow (3.1% vs. 10.0%, р = 0.013) remain significantly lower in the DS group. There were no differences in rates of death (4.4% vs. 6.9%, p = 0.454), MACE (6.3% vs. 8.1%, p = 0.664), stent thrombosis (1.9% vs. 0.6%, p = 0.625), and repeat myocardial infarction (0.6% vs. 0.6%, р = 1,00) between groups. </p><p><strong>Conclusion.</strong> Direct stenting in patients with ST-elevation myocardial infarction and hyperglycemia is a safe and feasible technique. Direct stenting in patients with hyperglycemia undergoing percutaneous coronary intervention for ST-elevation myocardial infarction was characterised with decrease in no-reflow rate.</p>

scholarly journals Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention

2016 ◽  
Vol 73 (8) ◽  
pp. 774-778 ◽  
Author(s):  
Predrag Djuric ◽  
Slobodan Obradovic ◽  
Zoran Stajic ◽  
Marijan Spasic ◽  
Radomir Matunovic ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Coronary Intervention ◽  
Stent Fracture ◽  
Bare Metal ◽  
Thrombus Aspiration ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Percutaneous Coronary

Introduction. Stent thrombosis (ST) in clinical practice can be classified according to time of onset as early (0?30 days after stent implantation), which is further divided into acute (< 24 hours) and subacute (1?30 days), late (> 30 days) and very late (> 12 months). Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS) is quite different from those following drug-eluting stent (DES) implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI) related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI) with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion. Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.

scholarly journals Early coronary stent thrombosis after bare metal stent implantation

2014 ◽  
Vol 9 (2) ◽  
pp. 60-64
Author(s):  
Laxman Dubey ◽  
S Guruprasad ◽  
G Subramanyan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stent Thrombosis ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Intervention ◽  
Coronary Stent ◽  
Bare Metal ◽  
Major Drawback ◽  
St Segment Elevation ◽  
Percutaneous Coronary

Percutaneous coronary intervention with stenting has become the most widely performed procedure for the treatment of obstructive coronary artery disease. But, a major drawback of coronary stenting is the occurrence of stent thrombosis. Though rare, stent thrombosis can lead to ST segment elevation myocardial infarction or even sudden cardiac death. This is a case of early coronary stent thrombosis in a 58-year-old male patient, who presented with acute chest pain, Mobitz type II 2:1atrioventricular block and cardiogenic shock 15 days after percutaneous coronary intervention with bare metal stenting to the right coronary artery. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 60-64 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9690

Variability of Activated Clotting Time by Site of Sample Draw During Percutaneous Coronary Intervention: A Prospective Single-Center Study

Angiology ◽  
2021 ◽  
pp. 000331972199223
Author(s):  
Jacqueline H. Morris ◽  
Junsoo Alex Lee ◽  
Scott McNitt ◽  
Ilan Goldenberg ◽  
Craig R. Narins
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Unfractionated Heparin ◽  
Anticoagulation Therapy ◽  
Coronary Intervention ◽  
Clotting Time ◽  
Access Sheath ◽  
Arterial Blood ◽  
Activated Clotting Time ◽  
Guide Catheter ◽  
Percutaneous Coronary

The activated clotting time (ACT) assay is used to monitor and titrate anticoagulation therapy with unfractionated heparin during percutaneous coronary intervention (PCI). Observations at our institution suggested a considerable difference between ACT values drawn from varying arterial sites, prompting the current study. Patients undergoing PCI with unfractionated heparin therapy were prospectively enrolled. Simultaneous arterial blood samples were drawn from the access sheath and the coronary guide catheter. Differences between Hemochron ACT values were determined, and potential interactions with clinical variables were analyzed. Immediately postprocedure, the simultaneous mean guide and sheath ACTs were 327 ± 62 seconds and 257 ± 44 seconds, respectively, with a mean difference of 70 ± 60 seconds (P < .001). Nearly all (90%) ACT values obtained via the guide catheter were higher than the concurrent ACT drawn from the sheath. Logistic regression analysis demonstrated that lower weight-adjusted heparin doses and absence of diabetes were associated with a greater difference between the ACT values. We conclude that the ACT value is substantially greater when assessed via the guide catheter versus the access sheath. Although the biological mechanisms require further study, this difference should be considered when managing anticoagulation during PCI and when reporting ACT as part of research protocols.

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