Coronary artery spasm is sometimes an unrecognized cause of myocardial ischemia. Myocardial ischemia is not always a product of fixed stenosis; it can also be induced by dynamic, transient stenosis. The angiogram represents the current state of vasculature at the time of examination and absence of stenosis does not mean disease absence. We present a case of right coronary artery spasm that caused non-ST elevation myocardial infarction and arrhythmias and was induced again in the cath lab due to vasovagal reaction.
One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion.
Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability
Wellens’ syndrome, also known as LAD (left anterior descending) coronary T-wave syndrome, “widow maker” or warning sign, is a potentially unrecognized critical proximal LAD stenosis with possible fatal consequences. It can be associated with extensive acute anterior wall myocardial infarction, with left ventricular dysfunction and a lethal outcome within a few days after the onset of symptoms. It usually consists of a typical ECG finding in the precordial leads that represents a significant proximal LAD stenosis in patients with unstable angina pectoris. Although this syndrome is not indicated for PCI (the patient is usually pain-free at the time of electrocardiography registration), it is necessary to recognize the characteristic pattern and perform an emergency coronary angiography and percutaneous or surgical revascularisation of the affected blood vessel. Here we present the case report of a 47 year-old woman without previous anamnesis of coronary disease. On admission to the Coronary Care Unit she was chest pain-free and had all the indicators of Wellens’ syndrome
ABBREVIATIONS
PCI-percutaneous coronary interventionPTFE-polytetrafluoroethylene NSTEMI-non ST segment elevation myocardial infarction LVH-left ventricular hypertrophy LAD-left anterior descending artery D1-first diagonal branch S1-first septal branch RCA-right coronary artery SC-semi compliant balloon DES-drug eluting stent BMS-bare metal stent CPR-cardiopulmonary resuscitation CABG-coronary artery bypass graft
CASE REPORTA 68 year old female was admitted to the cath lab due to complaints of postinfarction angina. She suffered an anterior NSTEMI 5 months prior to presentation. Her risk factors for cardiovascular disease were as follows: hypertension, diabetes, dyslipidemia, and a history of smoking. An electrocardiogram showed sinus rhythm, with a rate of 75 bpm, as well as signs of LVH and a reduced R in V2. Echocardiography revealed a reduced ejection fraction -40% and anterior wall hypokinesia. Angiography was performed, showing that the LAD was diffusely atherosclerotic and calcified, with tight stenosis approaching 90% of the vessel lumen immediately after the D1 and S1 branches (Figure1).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.