2024, Ischemia and Stent - Cardiovascular Update

SMT Publishes Trial Results for Supraflex Cruz Stent

DAIC

OCTOBER 16, 2024

tim.hodson Wed, 10/16/2024 - 09:00 Oct. 16, 2024 — Sahajanand Medical Technologies (SMT) recently announced the publication of the COMPARE 60/80 HBR trial results in Circulation: Cardiovascular Interventions , a journal of The American Heart Association. Led by Dr. Pieter C. and 17.1%, respectively (P=0.02 for noninferiority).

Stents

Stents Stent Thrombosis Coronary Artery Disease

FDA Breakthrough Device Designation for Biotronik Freesolve Below-the-Knee Resorbable Magnesium Scaffold (RMS)

DAIC

MARCH 20, 2024

milla1cf Wed, 03/20/2024 - 18:50 March 20, 2024 — Biotronik has been granted Breakthrough Device Designation (BDD) from the US Food and Drug Administration (FDA) for the Freesolve below-the-knee resorbable magnesium scaffold (BTK RMS). 2,3 It has shown 99.6% For more information: www.biotronik.com References: 1 Kwong M.,

Peripheral Arterial Disease

Peripheral Arterial Disease Innovation Technology Coronary Artery Disease

AI Measures Fat Around the Heart, a Key to Predicting Heart Attacks

DAIC

FEBRUARY 14, 2024

Diseased human arteries are most simply, reliably, and successfully treated with drug-eluting, balloon-expandable stents," said Lewis B. 2 An estimated 10% of patients with PAOD have its most severe form: chronic limb-threatening ischemia (CLTI). Eur J Vasc Endovasc Surg. 2012;43:55-61. J Am Heart Assoc. DOI: 10.1161/JAHA.118.009724.

Heart Attack

Heart Attack Heart attacks Peripheral Arterial Disease Ischemia

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Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. Many health care providers will simply not attempt to assess ischemia in the presence of a wide QRS. In the ECG above there are several features indicative of ongoing transmural ischemia. What do you think?

Chest Pain

Chest Pain Pacemaker Ischemia Stents

Abstract WP242: Comparison Between Right and Left Transradial Approach for Carotid Artery Stenting Using a 6-French Simmons Guiding Sheath

Stroke Journal

JANUARY 30, 2025

To our knowledge, no studies have directly compared the right and left TRA for carotid artery stenting (CAS). The right TRA was performed as a first-line approach from 2019 to 2021, with the left TRA being used thereafter. All carotid stenoses were successfully dilated.

Stents

Stents Stent Aortic Interventional Cardiology

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

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 baseline ECG is basically normal with no ischemia. In my opinion, I think it looks more like subendocardial ischemia.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

Three prehospital ECGs in patients with chest pain

Dr. Smith's ECG Blog

AUGUST 6, 2024

In any case, the ECG is diagnostic of severe ischemia and probably OMI. So this could be myocarditis but in my opinion needs an angiogram before making that diagnosis. == Dr. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging. Concordant STE of 1 mm in just one lead or 2a.

Chest Pain

Chest Pain Ischemia Pericarditis Tachycardia

Is OMI an ECG Diagnosis?

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. Int J Cardiol 2024 3. Eur Heart J Digital Health 2024 5. Amsterdam et al. Circulation 2014 2. Alencar et al.

STEMI

STEMI Chest Pain Myocardial Infarction Blog

Which of these, if either, is OMI? Which of these underwent emergent angiography and PCI? Which should have?

Dr. Smith's ECG Blog

JULY 14, 2024

The cath lab was activated, and then not cancelled, and the angiogram showed 99% TIMI 2 flow proximal LAD culprit lesion, stented in less than 90 minutes of arrival. Cath days later showed complete occlusion of the LAD, stented. Ultimately, cardiac cath was done in Case #2, with stenting of the "culprit" LAD lesion.

AFIB

AFIB Stents Stent Chest Pain

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

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. Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? The last echocardiography 12 months ago showed HFmrEF.

Tachycardia

Tachycardia Electrophysiology Atrial Flutter Ischemia

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Dr. Smith's ECG Blog

MARCH 22, 2024

The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. Ischemia can be disguised by a wide escape rhythm, which decreases the sensitivity of ECG.

Chest Pain

Chest Pain STEMI Bradycardia Ischemia

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

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. Whether these EKGs show myocarditis, a normal variant, or something else, they are overall not typical of transmural ischemia of the anterior or high lateral walls. It was stented.

Chest Pain

Chest Pain STEMI Echocardiogram Stents

Serial ECGs for chest pain: at what point would you activate the cath lab?

Dr. Smith's ECG Blog

AUGUST 11, 2024

Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. Cath lab was activated, and found a 95% proximal LAD occlusion which was stented. What do you think?

Chest Pain

Chest Pain STEMI Bradycardia Stents

The Computer and Overreading Cardiologist call this completely normal. Is it?

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia. RAO Caudal View Post PCI This is the RAO Caudal view after thrombectomy and stent placement. The conventional computer algorithm called “ sinus tachycardia, otherwise normal EKG ”.

Chest Pain

Chest Pain Blog Hospital Tachycardia

One-Year BIONETIC-I Study Results Show Safety and Effectiveness of Iliac Artery Treatment With BIOTRONIK’s Dynetic-35 Cobalt Chromium Balloon-Expandable Stent System

DAIC

MAY 30, 2024

milla1cf Thu, 05/30/2024 - 10:14 May 30, 2024 — B iotronik announced the presentation of the 12-month results from the BIONETIC-I study this week at LINC 2024. of enrolled patients had critical limb ischemia, 90% had calcified lesions (30.7% Presented at: LINC 2024; May 30, 2024; Leipzig, Germany.

Stents

Stents Stent Peripheral Arterial Disease Innovation

Preventive Percutaneous Coronary Intervention for High-Risk Coronary Plaques Reduces Cardiac Events

DAIC

APRIL 11, 2024

PCI is commonly used to open blocked arteries to treat significant myocardial ischemia , which occurs when the heart muscle does not get enough oxygenated blood. During PCI, an operator inserts a stent into a blocked artery through a catheter in the groin or arm.

Plaque

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GE HealthCare and Medis Medical Imaging Announce Collaboration Focused on Non-Invasive Coronary Assessments to Help Advance Precision Care in Treatment of Coronary Artery Disease

DAIC

MAY 14, 2024

The benefits of QFR guidance are supported in a recent study that showed that a QFR-guided strategy of lesion selection for PCI improved two-year clinical outcomes, including reduction in myocardial infraction and ischemia-driven revascularization, when compared with standard angiography guidance alone.2 Accessed May 2024.

Coronary Artery Disease

Coronary Artery Disease Interventional Cardiology Innovation Physiology

VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

JUNE 23, 2024

This was interpreted by the treating clinicians as not showing any evidence of ischemia. Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He was intubated in the field and sedated upon arrival at the hospital. Two subsequent troponins were down trending.

Chest Pain

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog

Abstract 48: Early Carotid Endarterectomy and Carotid Artery Stent Placement in Symptomatic Patients With Internal Carotid Artery Stenosis

Stroke Journal

FEBRUARY 1, 2024

Stroke, Volume 55, Issue Suppl_1 , Page A48-A48, February 1, 2024. Objective:To compare the 1-month stroke, myocardial infarction (MI), and/or death rates among symptomatic patients undergoing either CAS or CEA according to the timing of the procedure in Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).Methods:We

Stents

Stents Stent Stenosis Myocardial Infarction

Abstract TMP90: Extension of Subarachnoid Hemorrhage Following Mechanical Thrombectomy is Associated With Clinical Outcomes: A Subgroup Analysis of CLEAR Trial

Stroke Journal

FEBRUARY 1, 2024

Stroke, Volume 55, Issue Suppl_1 , Page ATMP90-ATMP90, February 1, 2024. At the end of the procedure, there was no statistically significant difference in successful recanalization rates defined as a Modified Treatment in Cerebral Ischemia (mTICI) score of 2b or greater (100% in non-diffuse vs. 90% diffuse, P>0.99).

Hemorrhage

Hemorrhage Outcomes Stents Stent

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

The operator performed intravascular ultrasound and visualized acute plaque rupture with thrombus formation and placed a stent. There was reperfusion ischemia superimposed on benign T-wave inversion. He is very lucky that he spontaneously reperfused and was stented before he had the chance to re-occlude.

Chest Pain

Chest Pain Ischemia Stents Stent

FDA Approvals (July 2024 – January 2025): Advancements in Cardiorenal and Cardiometabolic Health

Cardiometabolic Health Congress

JANUARY 2, 2025

August 2024 Approvals Minima Stent System (P240003) (Approval Date: August 28, 2024) The Minima Stent System is an expandable cobalt-chromium metal mesh tube to reopen blood vessels in neonates, infants, and children with Coarctation of the Aorta and Pulmonary Artery Stenosis, specifically designed to expand as younger patients grow.

Coronary Artery Disease

Coronary Artery Disease Stents Stent Innovation

An elderly woman with acute chest pain -- real or fake ST Elevation?

Dr. Smith's ECG Blog

DECEMBER 10, 2024

1) The ECG with active ischemia or reperfusion or subendocardial ischemia or nonspecific (no ischemia) 2) presence or absence of symptoms. (A 2) Rising troponin -- troponin leaks from infarcted myocardium for a long time after ischemia is gone and will rise for a long time. ECG #3 was obtained several hours after PCI.

Chest Pain

Chest Pain Ischemia Echocardiogram Stents

Carotid web : No longer a new kid in stroke risk

Dr. S. Venkatesan MD

JANUARY 14, 2025

2024 Nov 22;16(12):1294-1298. Management The web can create a flow disturbance, potentiating local thrombus formation, which can embolize producing resulting in cerebral ischemia. Current treatment is with anti-thrombotics and/or anticoagulation.Lesser option is to alter the flow disturbance caused by the web (surgery or stent).

Stroke

Stroke Strokes Ischemia Embolism

Can you treat Non-STEMI with thrombolytics if it is OMI (Occlusion MI)? Of course!

Dr. Smith's ECG Blog

OCTOBER 31, 2024

Here is the circumflex after stenting: Wide open The cardiologist called Dr. Lufkin back and said "Great call!!" Learn to read the ECG for sublte OMI, and get the Queen of Hearts. == MY Comment , by K EN G RAUER, MD ( 11/1 /2024 ): == The beauty of today's case is its simple efficiency.

STEMI

STEMI Arrhythmia Hospital Stents

What can you find with continuous ST monitoring in the ED?

Dr. Smith's ECG Blog

DECEMBER 3, 2024

The RCA was stented successfully with TIMI III flow noted post-procedure and the patient has done well with a post-PCI TTE demonstrating good LVEF and no wall motion abnormality. A good size infarct that no longer has active ischemia will have continually rising troponins due to the damage that was done hours ago.

Catheterization Laboratory

Catheterization Laboratory STEMI Blog Ischemia

Another MUST know ECG, and why its notoriety annoys Dr. Smith

Dr. Smith's ECG Blog

JANUARY 31, 2025

At cath there was a 100% proximal LAD occlusion, which was opened and stented. In this situation, even after the ischemia is relieved and myocardial blood flow is restored myocardial contractile function remains impaired for a variable period of time (usually days to a few weeks). Transient ischemia may lead to "stunning".

STEMI

STEMI Chest Pain Myocardial Infarction Ischemia

Chest (or abdominal?) pain and ECG artifact.

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

It was opened and stented. Compared to TTE from 7/3/24: the anterior regional wall motion abnormality is new and is consistent with ischemia/infarction in the LAD territory == MY Comment , by K EN G RAUER, MD ( 11/20 /2024 ): == There are several insightful aspects of today's case.

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Blog Chest Pain Myocardial Infarction Critical Care

Is it important to try to determine the culprit vessel based on ECG?

Dr. Smith's ECG Blog

JANUARY 5, 2025

Unfortunately, although natively conducted beats are the best ones for evaluating ischemia, we only have a few! Moving on to ischemia , the ECG shows reperfused inferoposterolateral infarct. There is just a hint of coving in leads III and aVF suggesting a component of active ischemia which fits with persistent pain.

Chest Pain

Chest Pain Ischemia Angina Echocardiogram

Chest pain and Saddleback STE. For Which of these 6 Cases should we Activate the cath lab? And how does the Queen of Hearts perform?

Dr. Smith's ECG Blog

OCTOBER 30, 2024

Ischemia often produces a straightening of the ST segment and sometimes upward convexity. At cath later the same day, a proximal 99% RCA culprit lesion was stented. Discussion: When a patient presents with chest pain and ST segment elevation we need to evaluate whether or not the ST elevation is ischemic in nature.

Chest Pain

Chest Pain Aortic Myocardial Infarction STEMI

SMT Publishes Trial Results for Supraflex Cruz Stent

FDA Breakthrough Device Designation for Biotronik Freesolve Below-the-Knee Resorbable Magnesium Scaffold (RMS)

AI Measures Fat Around the Heart, a Key to Predicting Heart Attacks

Webinars

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Abstract WP242: Comparison Between Right and Left Transradial Approach for Carotid Artery Stenting Using a 6-French Simmons Guiding Sheath

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Three prehospital ECGs in patients with chest pain

Is OMI an ECG Diagnosis?

Which of these, if either, is OMI? Which of these underwent emergent angiography and PCI? Which should have?

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

A 50-something with chest pain. Is there OMI? And what is the rhythm?

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Serial ECGs for chest pain: at what point would you activate the cath lab?

The Computer and Overreading Cardiologist call this completely normal. Is it?

One-Year BIONETIC-I Study Results Show Safety and Effectiveness of Iliac Artery Treatment With BIOTRONIK’s Dynetic-35 Cobalt Chromium Balloon-Expandable Stent System

Preventive Percutaneous Coronary Intervention for High-Risk Coronary Plaques Reduces Cardiac Events

GE HealthCare and Medis Medical Imaging Announce Collaboration Focused on Non-Invasive Coronary Assessments to Help Advance Precision Care in Treatment of Coronary Artery Disease

VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Abstract 48: Early Carotid Endarterectomy and Carotid Artery Stent Placement in Symptomatic Patients With Internal Carotid Artery Stenosis

Abstract TMP90: Extension of Subarachnoid Hemorrhage Following Mechanical Thrombectomy is Associated With Clinical Outcomes: A Subgroup Analysis of CLEAR Trial

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

FDA Approvals (July 2024 – January 2025): Advancements in Cardiorenal and Cardiometabolic Health

An elderly woman with acute chest pain -- real or fake ST Elevation?

Carotid web : No longer a new kid in stroke risk

Can you treat Non-STEMI with thrombolytics if it is OMI (Occlusion MI)? Of course!

What can you find with continuous ST monitoring in the ED?

Another MUST know ECG, and why its notoriety annoys Dr. Smith

Chest (or abdominal?) pain and ECG artifact.

Is it important to try to determine the culprit vessel based on ECG?

Chest pain and Saddleback STE. For Which of these 6 Cases should we Activate the cath lab? And how does the Queen of Hearts perform?

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