not availableNorthern International Medical College Journal Vol.5(2) 2014: 357-359
Background: Worldwide primary angioplasty is a recommended strategy of reperfusion in patient with acute myocardial infarction as because it ensures reperfusion of the infarct-related vessels more than 90% where as, with thrombolytics it is only 60-70%. Methods: It is a retrospective observational study includes all patients treated with primary angioplasty at United Hospital from Between6. Written consent must be taken from the patients or patient's relative.7. We have ongoing program to analysis outcomes. Study population:Inclusion criteria-1. Patient presented with chest pain, ECG changes suggestive of STEMI 2. Duration of pain < 12hours 3. All age group 4. Both sexes Underwent Primary PCI as a reperfusion strategyExclusion criteria 1. patient presented with cardiogenic shock 2. Chest pain > 12hours Medications and technique:All patients got aspirin 300mg and 600mg clopidogrel, GTN-oral/IV, 5000units IV heparin at Emergency Department immediacy after diagnosis. In Cath lab 10,000 units IV Heparin before initiation of PCI was given, some times more Cardiovas Journal heparin needed to keep ACT .300. We used intracoronary GTN, Adenosine if there was slow flow or no flow. IV GPIIb/IIIa receptor blockers bolus followed by IV infusion no flow or slow or huge thrombus burden. We did not use distal protection device. Following PCI 3-6 doses of LMWH subcutaneously given routinely if there is no bleeding episodes. Introducing sheath were removed 2 hours after completion of GPIIb/IIIa receptor blockers or 6 hours after completion of the procedure.From emergency patients were shifted directly to the cath-lab. Both arterial and venous femoral access was achieved immediately. TPM was implanted if bradycardia or heart block present at presentation. We used aspiration thrombectomy catheter before ballooning if there was thrombus burden. Pre-dilatation with balloon was done if lesion morphology were complex and critical after thrombus aspiration. In our protocol we did angioplasty to the infarct related artery then staged PCI or CABG. Most of the cases we put DES stents except when clinical condition demand BMS. We routinely did post dilatation after stent implantation. Results:Total 237 Discussion:There is no question that primary PCI, when available, is the treatment of choice. 7 But in our country it is not a widely used reperfusion strategy due to lack facilities. Only a few centers at Dhaka city are performing primary PCI but mostly during the office hours. But in our centre we have Primary PCI facilities 24hours a day, 365days a year. Study population was mostly male like all over the world. Regarding age we had younger age group, mean age 55.8± 11.5yrs, another study at USA showing their mean age 61±.13yrs. 8 Lowest age in our series was 28yrs. Risk factors analysis showed HTN is the most common it was 58.4%, it is also like other studies. A study at USA described HTN as the most common risk factor. 8 Primary PCI holds a survival advantage if it can be performed in a timely fashion. The principle that "time ...
Background: Carotid angioplasty & stenting is becoming an emerging therapeutic option for carotid revascularization. The use of cerebral protection system has expanded the area of application of the procedure worldwide. Purpose: To assess the feasibility, success rate, safety as well as in-hospital & early 30 days outcome in patients undergoing percutaneous carotid intervention. Methods: A retrospective, observational study where a total of 18 (Eighteen) consecutive patients who presented with symptomatic and > 70 % carotid artery stenosis & asymptomatic but > 90% stenosis underwent percutaneous carotid intervention. All of them had coronary artery disease; CABG was done in 3 patients & PCI in 9 patients. Three of them had previous stroke (Ischemic) & 7 had TIA. Results: Technical and angiographic success was achieved in all patients. Carotid artery obstruction diminishes from 85 ± 14 % to 10 ± 5 % (p< .001). Mean lesion length was 12 ± 3 mm and mean time of carotid occlusion during balloon inflation was 10 ± 2.5 sec. distal protection devices used in all patents. No major stroke or death occurred during procedure. One patient developed No-flow because of obstruction of distal protection device which was managed by thrombosuction. One patient developed TIA. All patients were discharged from hospital after an average of 3 days & all of them were prescribed dual antiplatalet therapy for 6 months. During follow-up one patient died secondary to acute myocardial infarction and one patient developed major stroke. Conclusion: Percutaneous angioplasty and stenting associated with distal protective devices appear feasible, effective and almost safe endovascular treatment modality for carotid artery stenosis. Key words: Carotid artery disease; Carotid angioplasty DOI: 10.3329/cardio.v2i2.6644Cardiovasc. j. 2010; 2(2) : 218-222
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