scholarly journals DEFERRED STENT IMPLANTATION IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND MASSIVE CORONARY THROMBOSIS

2018 ◽  
Vol 33 (2) ◽  
pp. 16-20 ◽  
Author(s):  
Ya. V. Alekseeva ◽  
E. V. Vyshlov ◽  
V. A. Markov ◽  
S. V. Demyanov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stent Implantation ◽  
Coronary Thrombosis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment

By researches it is proved that the phenomenon of no-reflow is an independent predictor of remodeling of the left ventricle at the moment. Particular importance in formation of this phenomenon is the fragmentation of a thrombus with distal embolization of small vessels, which often arise as a complication of the percutaneous coronary intervention during the destruction of a thrombus. Attempts to prevent the development of microvascular obstruction led to the creation of delayed stenting.The Purpose:assessing the efficacy and safety of deferred stent implantation in patients with ST-segment elevation myocardial infarction and massive coronary thrombosis.Material and Methods.12 patients with STEMI are included in a research. In the course of emergency coronary angiography was performed a massive thrombosis of the infarct-related coronary artery was observed with TIMI 2–3 blood flow. The emergency stenting wasn’t carried out to these patients, but continued anti-thrombotic therapy within 24 hours. After one day, repeated the coronary angiography was performed and, according to the indications, performed stenting of residual stenosis.Results.Development of the phenomenon of no-reflow, deaths and coronary events due to reocclusion of the infarctrelated coronary artery at all patients wasn’t observed. Also, all patients had a positive angiographic result in the form of regurgitation of the thrombus as a result of repeated the coronary angiography.Conclusion.Two-stage revascularization with delayed-on-day stenting with massive thrombosis of the infarct-related coronary artery in patients with acute myocardial infarction combined with aggressive antithrombotic therapy may be use in clinical practice to reduce the risk of developing the no-reflow phenomenon.

scholarly journals Delayed endovascular surgery in patients with acute ST-segment elevation myocardial infarction due to massive culprit arterial thrombosis in the prevention of slow/no-reflow phenomenon

2021 ◽  
Vol 20 (5) ◽  
pp. 2761
Author(s):  
A. V. Azarov ◽  
S. P. Semitko ◽  
A. S. Zhuravlev ◽  
D. G. Ioseliani ◽  
I. Kh. Kamolov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Stent Implantation ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Coronary Artery Stenting ◽  
No Reflow Phenomenon ◽  
Myocardial Blush Grade

Aim. To assess whether delayed coronary artery stenting (CAS) can reduce the slow/no-reflow incidence in patients with ST-segment elevation myocardial infarction (STEMI) and massive thrombosis (TTG ≥3) of the infarct-related coronary artery (IRCA) compared with immediate CAS within primary PCI.Material and methods. Out of 3651 primary PCIs performed for acute STEMI in the period from January 2016 to May 2020 at the Mytishchi City Clinical Hospital, the retrospective analysis included 105 patients with massive IRCA thrombosis (TTG ≥3). The patients were divided into two groups: first group (n=55) — delayed CAS, second group (n=50) — immediate CAS. In the immediate CAS group, the PCI procedure ended with routine stent implantation, and in the delayed CAS group, stent implantation was delayed for at least 5 days.Results. In the delayed CAS group in comparison with immediate one, the slow/no-reflow phenomenon developed much less frequently in the form of a significant increase in the prevalence of TIMI 3 flow, better myocardial perfusion of myocardial blush grade (MBG) 2-3 (81,8 vs 64%; odds ratio (OR) 2,53; p=0,039) and ST segment resolution ≥70% (87,3% vs 58%; OR 4,97; p=0,001).Conclusion. Delayed CAS in patients with STEMI with massive thrombosis (TTG ≥3) of IRCA reduces the risk of slow/no-reflow phenomenon and can be considered as a possible alternative treatment vs immediate CAS, provided that stable coronary flow is restored before TIMI 3.

The effects of percutaneous coronary intervention on mortality in elderly patients with non-ST-segment elevation myocardial infarction undergoing coronary angiography

2020 ◽  
Vol 65 (3) ◽  
pp. 81-88
Author(s):  
Pınar D Gündoğmuş ◽  
Emrah B Ölçü ◽  
Ahmet Öz ◽  
İbrahim H Tanboğa ◽  
Ahmet L Orhan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
One Year

Introduction Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. Methods Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. Results Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. Conclusion The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.

No-reflow phenomenon in ST-segment elevation myocardial infarction: still the Achilles’ heel of the interventionalist

2020 ◽  
Author(s):  
Jonathan L Ciofani ◽  
Usaid K Allahwala ◽  
Roberto Scarsini ◽  
Avedis Ekmejian ◽  
Adrian P Banning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Management Algorithms

Improvements in systems, technology and pharmacotherapy have significantly changed the prognosis over recent decades in patients presenting with ST-segment elevation myocardial infarction. These clinical achievements have, however, begun to plateau and it is becoming increasingly necessary to consider novel strategies to further improve outcomes. Approximately a third of patients treated by primary percutaneous coronary intervention for ST-segment elevation myocardial infarction will suffer from coronary no-reflow (NR), a condition characterized by poor myocardial perfusion despite patent epicardial arteries. The presence of NR impacts significantly on clinical outcomes including left ventricular dysfunction, heart failure and death, yet conventional management algorithms neither assess the risk of NR nor treat NR. This review will provide a contemporary overview on the pathogenesis, diagnosis and treatment of NR.

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