Cases reported "Myocardial Infarction"

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1/9. Rationale for directional atherectomy and adjunctive stenting in a patient with non-Q wave myocardial infarction.

    The development of percutaneous transluminal balloon angioplasty (PTCA) is the greatest revolution in the management of stenotic coronary artery disease. However, PTCA is limited in its application to some specific subgroups of complex lesions such as bifurcational, ostial and plaque burden lesions. For this reason, some new strategies including directional atherectomy (DCA) have been developed as advanced modalities in the treatment of these complex lesions, which if treated by PTCA would certainly yield poor outcomes. We report a case of non-Q wave myocardial infarction resulting from obstruction of the ostium of left anterior descending artery. DCA and adjunctive stenting to the lesion were successfully performed and the patient was discharged uneventfully after the procedure. We suggest that DCA is a striking method and has much merit in the treatment of complex lesions with a high rate of success. In view of consideration of restenosis remains an importantly unresolved problem in percutaneous coronary intervention in specific subgroups of complex lesions. In the future, adequate debulking by mean of DCA in combination with adjunctive stenting which recently emerges as a promising treatment in the prevention of restenosis may provide a more consistent and attractive method for prevention of restenosis in these complex lesions.
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2/9. Utility of mechanical rheolysis as an adjunct to rescue angioplasty and platelet inhibition in acute myocardial infarction and cardiogenic shock: a case report.

    We describe the value of mechanical rheolysis as an adjunct to rescue angioplasty and platelet glycoprotein IIb/IIIa receptor inhibition in a patient with acute myocardial infarction and cardiogenic shock in whom the severity of the intracoronary thrombus burden precluded restoration of antegrade coronary flow by conventional balloon angioplasty and stenting.
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3/9. Laser-facilitated thrombectomy: a new therapeutic option for treatment of thrombus-laden coronary lesions.

    To overcome the adverse complications of balloon angioplasty in thrombus burden lesions (i.e., distal embolization, platelet activation, no-reflow phenomenon with persistent myocardial hypoxemia), mechanical removal of the thrombus or distal embolization protection devices is required. Pulsed ultraviolet excimer laser light at 308 nm can vaporize thrombus and suppress platelet aggregation. Clinical experience has already shown its efficacy in acute ischemic-thrombotic acute coronary syndromes. Unlike other thrombectomy devices, a 308 nm excimer laser can ablate thrombi as well as the underlying plaque, speed up thrombus clearing, and enhance thrombolytic and GP IIb/IIIa activity. It can also be employed in patients with contraindications for systemic thrombolytic agents or GP IIb/IIIa antagonists. Our report covers clinical data and technical aspects concerning three patients with acute myocardial infarction who presented with a large thrombus burden. After successful laser-transmitted vaporization of the thrombus mass in these patients, the remaining thrombus burden was evacuated, and normal antegrade coronary flow was successfully restored. This approach can be useful for selective patients with acute coronary syndromes.
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4/9. myocardial infarction due to myocardial bridging.

    myocardial bridging is a rare coronary anomaly which is generally considered to be benign. Although the hemodynamic burden exerted by this entity has been demonstrated by intravascular ultrasound and Doppler studies, there are few reports of bridge-related infarction accompanied by severe hemodynamic compromise. We report one such patient who presented with acute infarction and cardiogenic shock.
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5/9. Late coronary stent thrombosis associated with exercise testing.

    We report a case of coronary stent thrombosis that occurred 6 months after the primary stenting of the left anterior descending coronary artery for acute myocardial infarction in a 75-year-old man. The reinfarction occurred the day after the demonstration of persistent optimal result of the percutaneous coronary intervention and immediately after exercise testing. A combined approach of a mechanical thrombus burden reduction by using AngioJet thrombectomy with adjunctive glycoprotein IIb/IIIa antagonist was performed, resulting in the complete removal of filling defects on the angiography.
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6/9. Persistent and proximal migration of a large coronary thrombus during percutaneous coronary intervention in the setting of acute Q-wave myocardial infarction.

    We describe a patient with an acute inferior myocardial infarction. Patient was taken to the cardiac catheterization laboratory for primary angioplasty. angiography revealed 100% occluded proximal right coronary artery (RCA). After initial balloon angioplasty of the occluded RCA, a very large mobile thrombus was seen in the proximal RCA. Despite multiple stenting, suctioning through the guide catheter lumen, and intracoronary thrombolytic therapy, the thrombus persisted and migrated proximally after each stenting. However, patient did well despite of persistent large thrombus burden in the proximal RCA on aggressive antithrombotic treatment.
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7/9. Spontaneous late thrombolysis of an occluded saphenous vein graft subsequent to acute myocardial infarction treated with percutaneous coronary intervention to the native culprit vessel.

    A 67-year-old male with prior history of myocardial infarction and coronary artery bypass grafting (individual vein grafts to the left anterior descending artery [LAD] and right coronary artery) presented with an acute anterior ST elevation myocardial infarction and cardiogenic shock. The vein graft to the LAD was occluded with heavy thrombus burden and there was severe native CAD. Given the degree of thrombus burden and other anatomic considerations, percutaneous intervention with stenting was performed to the native proximal LAD. Three months later, after complaining of atypical chest pain, repeat angiogram revealed a spontaneous widely patent vein graft to the LAD and occluded proximal LAD.
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8/9. Pronto catheter thrombectomy in acute ST-segment myocardial infarction: a case series.

    Primary angioplasty has emerged as the treatment of choice in acute ST-elevation myocardial infarction. While the timely restoration of infarct artery patency is central, close attention needs to be paid to microvascular integrity for successful restoration of normal myocardial metabolism. Clearance of thrombus burden is central to restoring normal myocardial metabolism. Available therapies do not efficiently remove thrombus in a timely and simple fashion. Microthrombi can be treated with appropriate pharmacological therapy, whereas larger macrothrombi should be treated with commercially available thrombectomy devices. In these case reports, the use of the Pronto (Vascular solutions, Inc., Minneapolis, minnesota) catheter is described as a quick, simple, and timely tool for the management of thrombus in the setting of an acute right coronary artery myocardial infarction.
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9/9. Papillary muscle rupture complicating acute myocardial infarction. Treatment with mitral valve replacement and coronary bypass surgery.

    Six cases of complete or partial rupture of the papillary muscle after acute myocardial infarction are presented. All cases were treated by mitral valve replacement and concomitant coronary bypass surgery. An average delay of 3 days between rupture and operation occurred in the four patients with rupture of the main muscle trunk. The operative mortality rate was 50 percent. Such patients present with acute, florid left ventricular failure secondary to the severe mechanical burden imposed on the newly infarcted heart. The resulting valvular incompetence must be corrected by urgent mitral valve replacement if survival is to be lengthened. patients with partial or apical head ruptures have a lesser degree of regurgitation and symptoms are largely dependent on intrinsic ventricular function. Both of our patients with partial muscle rupture presented with severe heart failure 2 to 4 months later, and both did well postoperatively. We believe that prompt operation without prolonged attempts at medical stabilization is the key to decreasing operative mortality, especially in instances of complete muscle rupture. Since ischemic heart disease remains the leading cause of death in such patients, coronary artery bypass surgery should be performed in conjunction with valve replacement.
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