scholarly journals Direct or Direct-Like Stenting in Acute Stemi with High-Grade Thrombus: A Clinical Case Series

2021 ◽  
Vol 4 (13) ◽  
pp. 01-07
Author(s):  
Rohit Mody
Keyword(s):  
Blood Flow ◽  
Heart Muscle ◽  
Case Series ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
High Grade ◽  
Landing Zone ◽  
Acute Stemi ◽  
Direct Stenting ◽  
St Elevation

We consider herewith acute ST-elevation myocardial infarction cases having high grade thrombus who underwent direct stenting or direct like stenting of the culprit vessel in those a drug-eluting stent was not crossable directly or distal landing zone was not visible directly after successful guidewire navigation in distal true lumen. All the 4 patients had presented with acute STEMI and high-grade thrombus on angiography. All of them were treated with percutaneous coronary intervention incorporating either direct stenting or direct like stenting. All had a very good angiographic outcome with TIMI 3 flow and MBG >/= 2. In most patients with acute STEMI and high-grade thrombus, direct or direct-like stenting is possible, it simplifies the procedure with almost nil on table complications. Twee table abstract Direct and direct-like stenting in patients with high grade thrombus with STEMI is possible in most of the patients. It resulted in TIMI 3 flow and MBG 2 in all our patients. None of them had no-reflow phenomenon. Lay Abstract In any case of ST-elevation MI, time is one of the most important aspects. In this process, it is important to minimize the damage to the heart muscle. Therefore, we need to open the culprit artery in a timely and urgent fashion to restore the blood flow to the heart muscle as quickly as possible. During this restoration of the blood flow, we need to minimize the distal embolization of the clot which may be detrimental to the heart muscle. Here, we describe the cases where we have done stenting directly without touching the clot and that resulted in minimal embolization and better outcomes.

scholarly journals A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right

2019 ◽  
Vol 6 (7) ◽  
pp. 2598
Author(s):  
C. P. Karunadas ◽  
Cibu Mathew
Keyword(s):  
Beta Blockers ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well. 

scholarly journals The role of intracoronary thrombolysis in selected patients presenting with ST-elevation myocardial infarction: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-10
Author(s):  
Sumita Barua ◽  
Paul Geenty ◽  
Tejas Deshmukh ◽  
Cuneyt Ada ◽  
David Tanous ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Plaque Rupture ◽  
Case Series ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Subsequent Increase ◽  
Intracoronary Thrombolysis ◽  
St Elevation ◽  
Distal Protection

Abstract Background Primary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies. Case summary This series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization. Discussion Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.

scholarly journals Late Stent Thrombosis in a Patient of Clopidogrel Resistance: A Case Report

2012 ◽  
Vol 2 (2) ◽  
pp. 45-49
Author(s):  
F Aaysha Cader ◽  
M Maksumul Haq ◽  
Sahela Nasrin ◽  
CM Shaheen Kabir ◽  
Rita Mayedah
Keyword(s):  
Stent Thrombosis ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Late Stent Thrombosis ◽  
Fatal Complication ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
St Elevation ◽  
Verify Now

Late stent thrombosis (LST) following drug-eluting stent (DES) implantation is a rare but very fatal complication after percutaneous coronary intervention (PCI). We report a case of LST presenting as non ST elevation myocardial infarction (NSTEMI) at 11 months after deployment of DES. The patient, initially managed with conventional dual-antiplatelet therapy (aspirin and clopidogrel) showed resistance to Clopidogrel on Verify Now P2Y12 assay, and was subsequently substituted with prasugrel. Ibrahim Cardiac Med J 2012; 2(2): 45-49

scholarly journals Reduction in Door-to-Needle Time after Transfer of Thrombolysis Site from CCU to Emergency Department

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Osama Mohammed ◽  
Firjith C. Paramba ◽  
Naushad V. Aboobaker ◽  
Riyadh A. Mohammed ◽  
Nishan K. Purayil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Coronary Care Unit ◽  
Coronary Intervention ◽  
Coronary Perfusion ◽  
Acute Stemi ◽  
Percutaneous Coronary ◽  
Duration Of Hospitalization ◽  
St Elevation ◽  
Coronary Care ◽  
Early Restoration

Objective. Early restoration of coronary perfusion by thrombolysis or percutaneous coronary intervention is the main modality of treatment to salvage the ischemic myocardium. The earlier the procedure is completed, the greater the benefit is in saving myocardium and restoring its functions. The aim of the study is to compare the door-to-needle time (DNT) in acute ST elevation myocardial infarction (STEMI) in the period prior to December 2008 when the site of thrombolysis was in coronary care unit (CCU) and the period after that when the site was shifted to emergency department (ED).Methods. A retrospective, descriptive study was conducted at Al Khor Hospital, Qatar, in patients with acute STEMI who underwent thrombolysis at CCU and ED from April 2005 until December 2011, to compare the DNT, duration of hospitalization, and mortality.Results. A total of 211 patients with acute STEMI were eligible for thrombolysis; 58 patients were thrombolysed in the CCU and 153 in ED. The median DNT was reduced from 33.5 minutes in the CCU to 17 minutes in the ED representing a reduction of more than 50% with aPvalue of < 0.0001.Conclusion. The transfer of the thrombolysis site from CCU to the ED was associated with a dramatic and significant reduction in median door-to-needle time by more than half.

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>

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