Background Myocardial recovery following primary percutaneous coronary intervention is often suboptimal despite of restoration of thrombolysis in myocardial infarction (TIMI) 3 flow, in part due to thrombus embolization which results in impairing microvascular reperfusion besides increasing infarct size. The purpose of the present study was to estimate the effect of aspiration thrombectomy followed by intracoronary delivery of tirofiban on decreasing the infarct size utilizing cardiac MRI (cMR) in large anterior ST-segment elevation myocardial infarction (STEMI) patients. Patients A prospective randomized controlled study of 100 patients with large anterior STEMI were randomized to (Study group) using intracoronary tirofiban (intracoronary) and (control group) without intocoronary tirofiban. A 6 F thrombus aspiration catheter was used in all patients. Tirofiban was injected locally at the place of the highly thrombus burden through the aspiration device after flushing the aspiration device well. Results Patients of intracoronary tirofiban group compared with control group had a significant difference in decreasing the infarct size at 30 days [median, 15.451 g – interquartile range (IQR), 17.404 gm – n = 50] vs (median, 43.828 g – IQR, 49.599 g – n = 50) P value = 0.002. Conclusion In patients early presented with large anterior STEMI, infarct size at 30 days was significantly decreased by intracoronary tirofiban delivered to the infarct lesion site followed aspiration thrombectomy.

Like breakthrough news of natural catastrophe, a radically different concept regarding the pathogenesis of multiple sclerosis (MS) has been proposed omitting the previous decades of research work in that field. Termed chronic cerebrospinal venous insufficiency (CCSVI), it suggests that macro occlusive abnormalities of the extracranial venous drainage pathways of the brain and spinal cord can cause or /and contribute to MS. Consequently, it has been suggested that angioplasty and possibly stenting of the internal jugular and/or azygos veins can improve the signs and symptoms of MS (Zamboni 2006; Zamboni, Menegatti et al. 2007). Since this breakthrough news a fierce pandemic has striked worldwide where these endovascular interventions have been performed sporadically across the globe in an open label fashion and never in the context of a well designed, controlled, randomized and blinded clinical trial. Despite this, this procedure 'liberation procedure' as it has been labeled by some ; sparkled a firestorm of interest in the medical and neurological communities, in both directions , to perform and not to perform. Each team has their rationale which is passionate at best, ranging from the myth that venous intervention is a miracle cure that must not be withheld from patients, to the feeling that the procedure is ineffective, unwarranted and dangerous at worst. The various views commonly see that those with differing beliefs are not acting in the best interest of the patients. As MS is a tuft practice of neurology, and neurointerventionalists interested in interventional treatment of neurological disorders are the neurology `s delivery man for neurointerventional procedures, we will attempt to analyze the available data and provide accordingly recommendations about whether or not endovascular treatment represents a reasonable option at this point of time for MS patients. To imagine the magnitude of a natural catastrophe, you should firstly bypass the denial phase to start counting the losses. So we will examine the source of the CCSVI theory and discuss the current data calling for or refuting its existence.

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