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This study compares outcomes in AF patients with GIB on AC alone to those on combination AP and AC therapy, as part of a larger prospective study from 2013 to 2023. Patients in the combination AP +AC therapy group had a higher prevalence of CAD, myocardial infarction, and coronary/vascular stent placement compared to the AC monotherapy group.
Stenting of the patent ductus arteriosus can be considered in neonatal period for improving oxygen saturation till corrective surgery. 2013 Dec;23(6):883-7. Anomalous coronary arteries can cross the right ventricular outflow tract and can be damaged during procedures needed for widening of the RVOT. Arch Med Sci Atheroscler Dis.
Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The image on the left shows the LAD before intervention, and the red circled portion on the right indicates the stented region.
One of our fine interns, Daniel Lee, who is also an ECG whiz, found this paper from 2013 and brought it to my attention: The delayed activation wave in non-ST-elevation myocardial infarction. A 100% occlusion on of the circumflex, proximal to the first obtuse marginal, was found, opened, and stented. The cath lab was activated.
LAD and D1 were stented, but flow unfortunately could not be well restored despite efforts (they list the post intervention TIMI flow still as 0). Serial tracings following stent placement confirmed the large extent of myocardial injury. LCX and RCA were described as "normal" in the cath report.
It was stented. Current Emergency and Hospital Medicine Reports (2013) 1:4352. The patient was taken for an angiogram and had an 80% LAD lesion, but it could not be definitely determined whether this was an acute thrombotic lesion or a chronic stable lesion. The troponin I peaked at 8.1. References : 1. Nikus KC, Eskola MJ.
He reported a history of ischemic cardiomyopathy with coronary stent placement approximately 10 years prior, but could not recall the specific artery involved. A 99% LAD occlusion was stented. BP 110/67 HR 68 RR 14 (non-labored) SpO2 95 RA Physical exam revealed slight pallor and diaphoresis. Attached is the first ECG.
It was opened and stented. This was formerly an indication for cath lab activation, but was abandoned in the 2013 guidelines because of poor specificity. Here is an algorithm that is very useful in such cases, published by Cai and Sgarbossa in 2013. The LAD was 100% occluded. Subsequent Peak cTnI was 46.84
Delayed angiogram found a 95% mid RCA occlusion that was stented. Arch Cardiovasc Dis 2013 Khan AR et al. Notice also that there is new T-wave inversion in III with upright T-wave in aVL, confirming inferior infarction. And notice that the T-waves in V4-V6 are now back down to normal size and "bulk." JAHA 2022 Grosmaitre P et al.
The role of intracranial stenting in ICAS remains uncertain. In the SAMMPRIS trial, patients who had experienced recent TIA/CVA secondary to 70‐99% ICAS demonstrated an increased risk of recurrent stroke when treated with angioplasty and stenting compared to medical therapy alone [1].
Jeffery Dormu was a double board certified vascular surgeon who was paid $13 million dollars by Medicare alone between 2013 and 2017. He is again sent to Dr. Dormu, who on the same day, performs another angiogram which revealed an in-stent restenosis of the superficial femoral artery stent and a 60% stenosis of the tibioperoneal trunk.
7) The 2013 ACC/AHA STEMI guidelines consider this a “STEMI equivalent,” where thrombolytic therapy is not contraindicated (Evidence level B, no specific class of recommendation).(16) Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. American heart journal 2010;160:995-1003,e1-8.
So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"!
After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all. SanzRuiz, R., Solis, J., &
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