Dr. Smith's ECG Blog

JANUARY 31, 2020

Angiogram: Widely patent RCA and LAD stents. Therefore, no stent was placed. (No It is proven better than angiography alone in stable angina , and also has been shown to improve decisions on stenting non-culprit lesions in ACS. We are told that this middle-aged male patient has a history of prior MI with stents.

Angina 52

Angina Stents Stent Aneurysm 52

Stroke Journal

FEBRUARY 1, 2024

Background:Persistent hypotension after carotid artery stenting (CAS) can lead to adverse outcomes, prolong length of stay (LOS), and increase hospital costs. A relation between decline of norepinephrine after stenting and persistent hypotension supports the role of catecholamine in BP control.

Stents 40

Stents Stent Blood Pressure Hypertension 40

Stroke Journal

FEBRUARY 1, 2024

Purpose:Since the balloon protection device became unavailable in Japan three years ago, the DWI-positive rate after carotid artery stenting (CAS) has increased. Stroke, Volume 55, Issue Suppl_1 , Page ATMP68-ATMP68, February 1, 2024. Symptomatic stenosis (63.9% vs. 94.7%, p<0.05) was more common in the with-POWER group.

Stents 40

Stents Stent Stenosis Embolism 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Current evidence suggests that acute carotid artery stenting (CAS) for cervical lesions is associated with better functional outcomes in patients with acute stroke with tandem lesions (TLs) treated with endovascular treatment (EVT). Stroke, Volume 55, Issue Suppl_1 , Page ATMP94-ATMP94, February 1, 2024.

Stents 40

Stents Stent Outcomes Angioplasty 40

Journal of the American Heart Association

DECEMBER 1, 2023

Recently, the ductus arteriosus stent (DAS) has become a viable alternative.Methods and ResultsThis was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock‐Taussig‐Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database.

Pediatrics 40

Pediatrics Stents Stent Pulmonary 40

Dr. Prateek Bhatnagar

OCTOBER 27, 2020

He next underwent stenting in his coronary arteries in 2000, 2010 and 2012 at Pune. A total of 6 stents were placed. Coronary angiography showed multiple blocks in the stents, needing an urgent bypass surgery. He himself developed heart disease a couple of years later. He recently developed unstable angina.

Open-Heart Surgery 52

Open-Heart Surgery Stent Stents Angina 52

Stroke Journal

FEBRUARY 1, 2024

We also compared the safety of acute carotid stenting (CAS) in TLs with low ASPECTS.Methods:This prospective multicenter study from 16 centers included patients with anterior circulation TL from 2015-2020. in patients with stenting (18/44) versus no-stenting (25/44).Conclusion:This 3.05; p=0.32), PH2 (OR: 1.14, CI: 0.26-5.02;

Stent 40

Stent Stents Stroke Strokes 40

The British Journal of Cardiology

APRIL 16, 2024

We present the cumulative percutaneous coronary intervention (PCI) data of all comers (stable angina and acute coronary syndromes [ACS]) who presented to Hadi Clinic between January 2018 and December 2020. A total of 567 patients underwent coronary catheterisation for the three-year period between January 2018 and December 2020.

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Open Heart

DECEMBER 13, 2022

Methods Between September 2011 and April 2020, 726 patients undergoing CTO PCI at 2 Belgian referral centres were prospectively included and divided into 4 groups based on postprocedural hs-TnT levels (unelevated; ≥5 times the upper limit of normal (ULN); ≥35 times the ULN; ≥70 times the ULN).

Stent 52

Stent Stents Hospital Stroke 52

Journal of Cardiothoracic Surgery

MARCH 12, 2024

Methods This retrospective study was conducted at a single center and involved 481 patients who received frozen elephant trunk stent implantation for TA-AAD. This study was performed at Fuwai Hospital between September 2016 and April 2020.

Aortic 40

Aortic Risk Factors Stent Stents 40

Dr. Smith's ECG Blog

APRIL 22, 2024

EKG from triage: Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in comparison to an EKG in 2020 this is new. Here are other very interesting posts: Wellens' syndrome: to stent or not?

Chest Pain 117

Chest Pain Myocardial Infarction Anatomy Angina 117

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. The case I presented in My Comment to that March 9, 2020 post showed a patient with this pattern — who on cath had no more than minimal coronary disease.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

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 121

STEMI Chest Pain Myocardial Infarction Blog 121

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 Stroke Strokes Angioplasty 40

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 125

STEMI Chest Pain Blog Pericarditis 125

Dr. Smith's ECG Blog

AUGUST 6, 2024

This led to immediate cath lab activation — which revealed total occlusion of a large 1st diagonal branch that was stented. == Below is the ECG of Patient #3 — recorded from a 35-year old man with sudden, new-onset CP. In a word — Patient #2 was lucky to have his ECG interpreted by the Queen Of Hearts. Sometimes — You have to be there.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Stroke Journal

JANUARY 30, 2025

The studies were classified in 3 periods by publication date: Period 1: before 2015, pre-stent retriever; Period 2: 2015-2019, early thrombectomy era; and Period 3: 2020-2024, recent period.Results:Of 2693 references, 21 trials met inclusion criteria, 3 in Period 1, 10 in Period 2, 8 in Period 3.

Stroke 40

Stroke Strokes Stent Stents 40

Dr. Smith's ECG Blog

MAY 23, 2023

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. There is ST elevation in lead aVL.

Chest Pain 98

Chest Pain STEMI Blog Stent 98

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionFlow diverters (FD) are stent‐type devices that enable the exclusion of intracranial aneurysms in clinical scenarios where coil‐type devices exhibit high failure rates. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. Adults older than 18 with non‐ruptured intracranial aneurysms were included.

Aneurysm 40

Aneurysm Embolism Angioplasty Stent 40

Stroke Journal

FEBRUARY 1, 2024

MT cases for strokes between 2020 and 2022 were reviewed. To be included, two or more passes of MT using stent retrievers in combination with aspiration must have occurred. Favorable functional outcomes were identified as mRS of 0 to 2 and NIHSS of 0 to 4 at discharge.

Stent 40

Stent Stents Outcomes Stroke 40

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 130

Chest Pain Myocardial Infarction Blog Stent 130

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ). The August 28, 2020 post ( LA-LL reversal ). The November 19, 2020 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ).

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

OCTOBER 12, 2023

Decision was made to stent the lesion. We review ECG findings in Takotsubo Cardiomyopathy in the March 25, 2020 post of Dr. Smith's ECG Blog. An echo was done and decision was made to pursue cath lab the following day as the echocardiography was interpreted as consistent with Takotsubo Cardiomyopathy.

Cardiomyopathy 110

Cardiomyopathy Stenosis Chest Pain Hospital 110

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The reappearance of de Winter's pattern caused by acute stent thrombosis: A case report. Am J Emerg Med. 2014;32:e5–e8. As per Drs.

Chest Pain 82

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Between 2020 and 2023, thirty cerebral aneurysms were treated with at least 80% utilization of the Balt Optima™ Coil System. Serious adverse events including, but not limited to, groin hematoma, periprocedural stroke, intraoperative aneurysm rupture, coil herniation requiring stent placement, and mortality were recorded.

Aneurysm 40

Aneurysm Embolism Stent Stents 40

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. It was stented. He wrote most of it and I (Smith) edited. He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. This was a large OMI.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

Dr. Smith's ECG Blog

DECEMBER 19, 2023

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. This is not the case.

Plaque 127

Plaque Angina Blog Stent 127

Stroke Journal

FEBRUARY 1, 2024

12.6), the rate of complete occlusion was 75.2% (91/121), ≥50% in-stent stenosis 7% (9/129), and retreatment 0.8% (1/129). Analysis included patients with unruptured wide-necked saccular aneurysms (not previously treated), measuring <12 mm along the ICA segments. Successful implantation was encountered in 99% (128/129) of the cases.

Aneurysm 40

Aneurysm Stenosis Academic Stent 40

Dr. Smith's ECG Blog

AUGUST 11, 2024

Cath lab was activated, and found a 95% proximal LAD occlusion which was stented. As Smith and Meyers explained in a 2020 article in EM News : “What should we do in the meantime while we are still stuck in the STEMI paradigm in daily practice? First, start using the terminology that allows our understanding to progress.

Chest Pain 100

Chest Pain STEMI Bradycardia Article 100

Dr. Smith's ECG Blog

JUNE 11, 2024

Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. To add to this complexity ( as per My Comment in the August 22, 2020 post in Dr. Smith's ECG Blog ) — the ST-T wave appearance in repolarization variants may be dynamic ! Below the limit of detection.

Chest Pain 113

Chest Pain STEMI Blog Exercise 113

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Only 24 patients received intravenous thrombolytics (5.3%) and 47 had stent placement (10.4%). A total of 3 separate groups, low‐dose ticagrelor (45 mg or 60 mg twice a day), full‐dose ticagrelor (90 mg twice a day) and clopidogrel (75 mg daily) were created. Out of 445 patients, 288 were on aspirin 81 mg at time of discharge.

Stroke 40

Stroke Strokes Hemorrhage Academic 40

Dr. Smith's ECG Blog

MARCH 22, 2024

And finally, after placement of a stent in the LAD: Before and after: (Unfortunately, this resulted in the "jailing" of the septal branches behind the stent and probably some degree of plaque shift which is why they do not opacify well in the "after" shot. This was the cost of preventing infarction of the anterior wall.)

Chest Pain 114

Chest Pain STEMI Bradycardia Ischemia 114

Ken Grauer, MD

AUGUST 26, 2023

C ASE C onclusion : Timely cardiac cath was performed on today's patient — with successful reperfusion and stenting of his proximal LAD occlusion. = The importance of the new OMI ( vs the old STEMI ) Paradigm — See My Comment in the July 31, 2020 post in Dr. Smith's ECG Blog.

Blog 145

Blog Chest Pain STEMI Ischemia 145

Dr. Smith's ECG Blog

JANUARY 28, 2023

hours after that first diagnostic ECG) : Mid-LAD culprit lesion, 99% stenosis, no pre-intervention TIMI flow available, but described as "severe subtotal lesion", which was stented with reported TIMI 3 flow resulting. Another lesion in the proximal LAD with 80% stenosis was stented as well. Culprit lesion was reduced to 0% and stented.

STEMI 52

STEMI Chest Pain Stent Stents 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The last echocardiography 12 months ago showed HFmrEF.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The culprit lesion was opened and stented. For those in search of brief review of the Cabrera Format for ECG recording — Please check out My Comment at the bottom of the page in the October 26, 2020 post 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

JANUARY 16, 2020

It was opened and stented with resulting TIMI-3 (normal) flow. The stent to LCX is patent. not left main occlusion == MY Comment by K EN G RAUER, MD ( 1/16/2020 ): == I did not correctly identify the “culprit artery” in this case. OM1 is occluded and OM2 has 60% stenosis.

Aneurysm 40

Aneurysm Heart Disease Stent Stents 40