Dr. Smith's ECG Blog

DECEMBER 27, 2023

Just before 10 AM, the patient received a stent to the culprit OM. We know that today's patient has had prior inferior OMI with stenting of his proximal RCA ~3 years earlier. In this view, the culprit lesion is not particularly obvious which is an important principle in angiography, and the reason why we obtain multiple views.

Chest Pain 129

Chest Pain Myocardial Infarction Blog Stent 129

Stroke Journal

JANUARY 30, 2025

ml/h, P = 0.04), a higher likelihood of parent artery stenosis (65% vs. 20.8%, P < 0.001), and increased need for angioplasty or stenting (50% vs. 17%, P < 0.001). Follow-up lesion volumes and functional outcomes were similar; however, the mismatch group showed a slower infarct growth rate (3.8 ml/h vs. 7.5 vs. 21.2%, P = 0.02).Conclusions:DWI-ADC

Outcomes 40

Outcomes Strokes Stroke Angioplasty 40

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

At that visit the patient was found to have an in-stent RCA occlusion. The patient was referred emergently to the cath lab, and again there was an in-stent RCA occlusion. As I illustrated in detail in My Comment of the October 3, 2018 post of Dr. Smith's ECG Blog — I favor a qualitative approach based on shape.

Chest Pain 111

Chest Pain Pacemaker Ischemia Stent 111

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The patient was transferred to CCU to consider surgical options.

STEMI 120

STEMI Chest Pain Myocardial Infarction Blog 120

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

years) underwent surgery for unruptured anterior communicating artery aneurysms in our hospital between January 2018 and January 2023.ResultsThe Coil embolization was performed for fifty‐four patients using various adjunctive techniques (simple, 7; double catheter, 15; balloon neck remodeling, 7; stent‐assisted, 26 (LVIS Jr.,

Aneurysm 40

Aneurysm Embolism Stent Stents 40

Stroke Journal

JANUARY 30, 2025

Here we assess the efficacy of technique switching after the first pass failed reperfusion in a large multi-center cohort.Methods:All consecutive patients treated with EVT from 12 centers across the US were prospectively collected between 10/2018 12/2021 (SVIN Registry). Exclusion criteria included incomplete data.

Stent 40

Stent Stents Strokes Stroke 40

Circulation

NOVEMBER 11, 2024

Optimal management is controversial, with options including medical therapy (MT), endovascular stenting (ES), and surgical revascularization (SR). Propensity scores adjusted for baseline differences.

Stenosis 40

Stenosis Inpatient Stent Stents 40

Stroke Journal

FEBRUARY 1, 2024

The purpose of this study was to compare the outcomes of EVT for ICAD with those of cardiogenic cerebral embolism (CE) based on real-world data from a multicenter, prospective registry study (K-NET registry) involving 40 centers in Japan.Methods:The K-NET study enrolled 3187 EVTs in 2018-2021, of which 358 (11%) were ICAD and 1870 (59%) were CE.

Embolism 40

Embolism Outcomes Angioplasty Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

We aimed to evaluate the association between RS with functional outcomes compared to medical management (MM) in patients who underwent failed MT.Methods:This is a cross-sectional study using prospectively collected data from the Society of Vascular and Interventional Neurology (SVIN) Registry from 2018 to 2021.

Angioplasty 40

Angioplasty Strokes Stroke Stent 40

Stroke Journal

JANUARY 30, 2025

Background:Postoperative complication rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are recommended to be maintained below a certain threshold. Stroke, Volume 56, Issue Suppl_1 , Page ATP128-ATP128, February 1, 2025.

Hospital 40

Hospital Stenosis Outcomes Inpatient 40

All About Cardiovascular System and Disorders

JANUARY 14, 2024

Stenting of the patent ductus arteriosus can be considered in neonatal period for improving oxygen saturation till corrective surgery. 2018 Jun 28;3:e72-e79. Anomalous coronary arteries can cross the right ventricular outflow tract and can be damaged during procedures needed for widening of the RVOT. References Wagdy R. 2018.76824.

Congenital Heart Disease 52

Congenital Heart Disease Pulmonary Anatomy Congenital 52

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ). The November 4, 2018 post ( Leads V1,V2 misplacement ). The February 11, 2020 post ( LA-RA reversal ).

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

MAY 13, 2020

One would not expect wall motion to recover so quickly after stenting, so this is good evidence that the POCUS echo was indeed accurate. Angiogram: Severe diffuse left main disease, up to 80% at the ostial left main. Post cath ECG: Normal or near normal Peak troponin I was 15 ng/mL.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

The patient was found to have total "mid" LAD occlusion which was stented: Pre-PCI. Patient 2 Clinical Course and Outcome: This patients first ECG was sent to the EM physician who said it did not meet STEMI criteria, but wisely agreed with EMS to get serial ECGs during transport. The cath lab was now activated.

STEMI 124

STEMI Chest Pain Blog Pericarditis 124

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The patient underwent successful placement of one drug eluting stent with restoration of TIMI 3 flow.

Pericarditis 52

Pericarditis Chest Pain Stent Stents 52

Dr. Smith's ECG Blog

JULY 11, 2018

He did, found the true culprit, and went back in to stent it. Comment by KEN GRAUER, MD ( 7/11/2018 ): = Insightful blog post by Dr. Smith regarding ECG criteria for recognizing acute RV involvement in patients with inferior STEMI. Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion This is the ECG.

Chest Pain 52

Chest Pain STEMI Ischemia Blog 52

EMS 12-Lead

JUNE 20, 2022

He was rushed to the Cath Lab where an LAD culprit lesion was stented. Here is the LAD after stent placement. This is to suggest improved TIMI flow – most likely a combination of the ASA administration in tandem with the body’s own natural tPA – yet the ECG still retains signatures of an active thrombus. 3] Aslanger, E.,

STEMI 52

STEMI Stent Stents Myocardial Infarction 52

EMS 12-Lead

APRIL 2, 2022

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. 5] Walsh, B.

Myocardial Infarction 52

Myocardial Infarction Stent Stents STEMI 52

Dr. Smith's ECG Blog

MARCH 27, 2025

The total occlusion was recanalized and stented from 100 to 0%. ii ) Since it is now 7 years since initial publication of the OMI Manifesto ( See the April 18, 2018 post in Dr. Smith's ECG Blog ) We would have expected that emergency providers ( especially cardiologists!

STEMI 79

STEMI Chest Pain Pericarditis Ischemia 79

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

The patient was then taken to the cath lab an found to have a proximal RCA 100% thrombotic occlusion which was successfully stented. J Electrocardiology January–February, 2018; Volume 51, Issue 1, Pages e5–e6. Progression of V2 showing posterior involvement.

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 52

EMS 12-Lead

APRIL 14, 2022

Troponin I returned 80 ng/mL, and the Cath Lab was then reactivated where a 100% LAD occlusion was found and stented. The nearest PCI center was activated but ultimately denied by Cardiology. Utility of the history and physical examination in the detection of Acute Coronary Syndromes in emergency department patients. 2] Costanzo, L.

ACE Inhibitor 52

ACE Inhibitor Physiology Chest Pain Academic 52

EMS 12-Lead

MAY 20, 2022

A mid-LAD culprit lesion was identified and stented. Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. Type II MI), however decided to pursue coronary angiogram out of an abundance of caution. Pacing Clin Electrophysiol. 40; 1234-1241.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 11, 2018

Angiogram showed a distal RCA occlusion which was stented. While the cath lab was getting ready, we recorded a right sided ECG: V1=V1R which is the same location as V2 V2 = V2R = same location as V1 V3-V6 = V3R - V6R Inferior MI is obvious There is no right ventricular MI evident on these ECGs. Echo showed inferior wall motion abnormality.

Chest Pain 52

Chest Pain Critical Care Blog Stents 52

Dr. Smith's ECG Blog

JUNE 28, 2018

Ed Burns has a very nice complete summary of Wellens' syndrome here: [link] = Comment by KEN GRAUER, MD ( 6/28/2018 ): = Highly insightful post with superb explanation by Dr. Smith, illustrating by sequential evolution over 5 serial tracings what Wellens’ Syndrome is, and what it is not. Here is the first post-cath ECG (ECG #4).

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Article 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The culprit lesion was opened and stented. For more on this mirror-image opposite ST-T wave relation in leads III vs aVL — See My Comment in the March 8, 2019 and August 9, 2018 posts in Dr. Smith's ECG Blog ). The QoH now recognizes the OMI with mid confidence. Below is the post -PCI electrocardiogram.

Chest Pain 60

Chest Pain Blog Ischemia Risk Factors 60

Dr. Smith's ECG Blog

JULY 31, 2018

The lesion was stented. Next day, t he patient was taken for an angiogram and found to have a reperfused LAD lesion with good flow that appeared to the angiographer as if it was a spontaneous coronary artery dissection. It seems that there was some uncertainly about this. Circ Cardiovasc Interv. 2012;5:134–137. 111.966630. Hayes, S.N.,

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused. To our knowledge, the patient did well.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. After many hours, the decided that it was appropriate to do an angiogram and they found a distal LAD occlusion which was opened and stented. It was stented. In summary: At a cutpoint of 17.0, it is 97% sensitive. At a cutpoint of 19.0, it is 97% specific. There was no wall motion abnormality.

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Here is his angiogram: This shot shows that the left circumflex (LCx) is occluded at the ostium (origin). This is seen just millimeters beyond the tip of the catheter. The patient recovered well.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Paddy Barrett

DECEMBER 5, 2023

The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina. All is fixed.

Stents 59

Stents Stent Angina Heart Attack 59

Dr. Paddy Barrett

NOVEMBER 28, 2023

One of the most common questions I get is, “ Do I need a stent to treat my heart disease?” ” Typically, several of this person’s friends have had stents, so it seems natural to ask. First, we must understand what a stent is and why it is used. The stent ‘unblocks’ it. Flow is restored.

Stents 53

Stents Stent Heart Attack Heart attacks 53

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Past medical history includes coronary stenting 17 years prior. A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. Pretest probability: Even before the ECG, a patient with a history of coronary stent has a 90% chance that his wide complex tachycardia is VT.

Tachycardia 138

Tachycardia Cardiogenic Shock Angina Blog 138

Dr. Anish Koka

JULY 23, 2023

In 2018, he even opened a state of the art lab nicknamed “the Watcher” and was paid $18 million from Medicare in the next 3 years. 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.

Vascular Care 52

Vascular Care Outpatient Peripheral Arterial Disease Stent 52

Circulation: Cardiovascular Interventions

OCTOBER 23, 2023

In-stent restenosis was excluded. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. versus 83.5%;P=0.036)

Angioplasty 40

Angioplasty Stent Stents Cardiovascular Interventions 40

All About Cardiovascular System and Disorders

APRIL 21, 2024

If the FFR normalizes after stenting, the restenosis rates at six months is less than 5%. Since the FFR wire can be used for guiding balloon catheters and stents, it is easy to make post procedure measurements without any additional effort. Routine FFR measurement probably lead to more judicious use of stents and improved outcomes.

Myocardial Infarction 52

Myocardial Infarction Stent Stents Coronary Artery Disease 52

DAIC

DECEMBER 14, 2023

Doctors then treat the cause of the heart attack, either inserting a stent, removing a clot or taking other necessary action. approximately 80,000 people are diagnosed with cardiogenic shock as a result from a heart attack each year according to data from a published study that looked at a 15-year trend from 2004 to 2018. In the U.S.,

Cardiogenic Shock 105

Cardiogenic Shock Heart Attack Heart attacks Myocardial Infarction 105

Frontiers in Cardiovascular Medicine

FEBRUARY 29, 2024

Method Between June 2018 and December 2022, 62 patients with type A aortic dissection (TAAD) underwent reoperation after previous surgical treatment. Outcome In the EVAR group, 47 patients (95.92%) were successfully implanted with overlapping stents, and 2 patients died in the perioperative period.

Aortic 49

Aortic Quality of Life Stent Stents 49