Increased risk of coronary perforation during percutaneous intervention of myocardial bridge: What histopathology says

Abstract

Introduction: Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention. Methods: Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery. Results: The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal. Conclusion: The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.

Myocardial bridges: A meta‐analysis

“…Thirty (30) articles gave prevalence data on myocardial bridges identified by autopsy or cadaveric dissection: (Acunã, Aristeguieta, & Tellez, 2009; Akishima‐Fukasawa et al, 2018 cited by Villela and de Oliveira, 2019; Bandyopadhyay, Das, Baral, & Chakroborty, 2010; Basso et al, 2009; Burnsides et al, 1956 cited by Möhlenkamp et al, 2002; Cakmak, Cavdar, Yalın, Yener, & Ozdogmus, 2010; Cukuranovic et al, 2019; Fabre & Sheppard, 2005; Fazliogullari et al, 2009; Ferreira et al, 1991; Geiringer, 1951 cited by Möhlenkamp et al, 2002; Karahan, Sürücü, & Karaöz, 1998; Kosiński & Grzybiak, 2001; Loukas et al, 2014; Loukas et al, 2006; Lujinović, Kulenović, Kapur, & Gojak, 2013; Micic‐Labudovic et al, 2015; Mohandas & Sitansu Ku, 2020; Nasr, 2014; Ongeti, Saidi, & Ogeng'o, 2010; Ortale, Gabriel, Iost, & Márquez, 2001; Ozbag & Kervancioglu, 2004; Polacek & Kralove, 1961 cited by Möhlenkamp et al, 2002; Pourhoseini et al, 2017; Reig, Ruiz de Miguel, & Moragas, 1990; Rozenberg & Nepomnyashchikh, 2002; Rozenberg & Nepomnyashchikh, 2004; Sujatha, Jayachandra, Ananda, & Subhadra, 2015; Teofilovski‐Parapid et al, 2017; Watanabe et al, 2016).…”

Challenges in Evaluation and Management of Children with Myocardial Bridging

“…Haager et al [66] stated that a stent eliminated external compression in the artery with bridging, increased the luminal width, and reduced symptoms, and these cases showed a good prognosis in a 2-year follow-up. In their cadaver study, Pourhusaini et al [67] claimed that changes in the proximal and distal parts and that the bridging part is thinner may be the reason for the higher rate of complications in invasive interventions. Nevertheless, stent application may be only suitable for a limited number of cases and at further ages due to its complications.…”

Hippocampal Astrocyte Response to Melatonin Following Neural Damage Induction in Rat

“…For histological evaluation, all rats were anesthetized with i.p. injection of 400 mg/kg chloral hydrate (Merck, 102425) (Mortezazadeh et al, 2018) at 72 h after brain trauma, and perfused intracardially with 140-180 ml of heparinized 0.9% saline, followed by 100 to 120 ml of 4% paraformaldehyde in phosphate buffered saline (PBS).indeed perfusion continued until the lungs and liver were clear of blood (for 10 to 15 min) (Babaee, Nematollahi-Mahani, Dehghani-Soltani, Shojaei, & Ezzatabadipour, 2019;Pourhoseini et al, 2017). Then, the brain of animals were cautiously removed and immediately transferred in 10% formaldehyde and maintained overnight at 4 °C.…”