Aneurysm, Ischemia and Stent - Cardiovascular Update

Comparison of Angiographic Outcomes of Woven EndoBridge and Balloon?Assisted Coiling for the Treatment of Ruptured Wide?Necked Aneurysms: A Multicentric Study

Stroke: Vascular and Interventional Neurology

FEBRUARY 15, 2024

BACKGROUNDThe optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Stroke: Vascular and Interventional Neurology, Ahead of Print. versus BAC: 2.8%;P=

Aneurysm

Aneurysm Outcomes Hemorrhage Stent

Abstract 254: Imaging Findings of Stroke Following Treatment of Ruptured Cerebral Aneurysm Increases Risk of Postoperative Delirium

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

5 ICSS‐ MRI study (International Carotid Stenting Study Magnetic Resonance Imaging Study), indicated that patients with periprocedural hemodynamic depression had decreased cerebral blood flow and increased the risk of new lesions in imaging.6 This is secondary to delayed postoperative cerebral ischemia and infarction caused by vasospasm.7

Aneurysm

Aneurysm Strokes Stroke Ischemia

Abstract 039: Angiographic Outcomes of Woven EndoBridge and Balloon?Assisted Coiling for the Treatment of Ruptured Wide?Necked Aneurysms

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionThe optimal endovascular approach for wide‐neck intracranial aneurysms (IAs) during the acute phase of bleeding remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks (1, 2).

Aneurysm

Aneurysm Outcomes Hemorrhage Stent

A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

JANUARY 6, 2023

I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. A CT was completed to rule out dissection, PE, or aneurysm, and this was unremarkable. A single DES stent was placed, and the patient did well post-procedure.

Chest Pain

Chest Pain Ischemia Myocardial Infarction ICU

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)? These are all findings that can be expected with left ventricular aneurysm.

Tachycardia

Tachycardia Electrophysiology Atrial Flutter Ischemia

Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

However, old MI w/aneurysm morphology (persistent ST-Elevation) can look just like this. While this may be change that is reciprocal to an Acute/Subacute Inferior STEMI, the problem is that LV aneurysm may also manifest with this reciprocal change. Old MI w/Aneurysm will show moderate ST Elevation, as seen here.

Chest Pain

Chest Pain Aneurysm STEMI Document

QS-wave in V2: 2 cases, different paradigms lead to different treatment times (STEMI - NSTEMI vs. OMI - NOMI)

Dr. Smith's ECG Blog

JANUARY 28, 2023

Prior ECG available on file from 2 months before: We do not know the clinical events happening during this ECG, but there is borderline tachycardia, PVCs, and likely some evidence of subendocardial ischemia with small STDs maximal in V5-6/II, slight reciprocal STE in aVR. QS waves from V2-V5 consistent with LV aneurysm morphology.

STEMI

STEMI Chest Pain Stent Stents

Nausea and Vomiting. This ECG is loaded with information.

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

Normal RBBB, no evidence of ischemia. It was opened and stented. This may be permanent and may be associated with echocardiographic dyskinesis (aneurysm). LV aneurysm is common in completed, full thickness (transmural) MI, which is what we have here. Here is the patient's previous ECG (Figure 2): Previous ECG.

Aneurysm

Aneurysm Ischemia Embolism STEMI

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. The EKG is diagnostic of acute inferior, posterior, and lateral OMI superimposed on “LV aneurysm” morphology. It was stented. He wrote most of it and I (Smith) edited.

Chest Pain

Chest Pain STEMI Echocardiogram Stent

PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." This is a very common misread. What do you think?

STEMI

STEMI Chest Pain Cardiac Arrest Stent

Chest pain with NonDiagnostic ECG but Diagnostic CT Scan

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

This transmural ischemia, but not necessarily completed infarction (yet). See more images of this case at Gopal's Spectral CT Blog: It's all about confidence With continued symptoms, an elevated troponin, and no other explanation, this is acute MI with ongoing ischemia until proven otherwise.

Chest Pain

Chest Pain Blog Ischemia Article

LVH with anterior ST Elevation. When is it anterior STEMI?

Dr. Smith's ECG Blog

DECEMBER 29, 2015

All these factors, again, support an ECG diagnosis of LVH The patient was nonetheless taken for emergency angiography, and a 99% mid-LAD lesion was found and stented. However, the ST segments in patients with LVH may show significant variation over time in the absence of ischemia. Is LVH like left ventricular aneurysm?

STEMI

STEMI Myocardial Infarction Chest Pain Aneurysm

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Persistent ST elevation 3 days after a nearly transmural MI portends possible LV aneurysm. It is very unlikely to be LV aneurysm morphology when the ST elevation is so high and the T-Wave inversion is so deep. An open 90% LAD was stented. This 42 yo diabetic male presented with cough and foot pain. The LAD has reperfused early.

STEMI

STEMI Myocardial Infarction Chest Pain Angioplasty

A young patient with diminishing pain with a subtle but diagnostic ECG.

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. Post-myocardial infarction (MI) ventricular septal defects are frequently seen in mid-anteroseptal and apical septal segments, whereas apex and the basal inferior segment are prone to aneurysm formation.

Myocardial Infarction

Myocardial Infarction Chest Pain Blog Echocardiogram

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

It was treated with and dual "kissing balloons" and drug eluting stents. Here is the post stent ECG: There is greater than 50% resolution of ST elevation (all but diagnostic of successful reperfusion) and Terminal T-wave inversion (also highly suggestive of successful reperfusion). Perhaps she will not develop an LV aneurysm.

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

Comparison of Angiographic Outcomes of Woven EndoBridge and Balloon?Assisted Coiling for the Treatment of Ruptured Wide?Necked Aneurysms: A Multicentric Study

Abstract 254: Imaging Findings of Stroke Following Treatment of Ruptured Cerebral Aneurysm Increases Risk of Postoperative Delirium

Abstract 039: Angiographic Outcomes of Woven EndoBridge and Balloon?Assisted Coiling for the Treatment of Ruptured Wide?Necked Aneurysms

A woman in her 50s with acute chest pain

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

Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?

QS-wave in V2: 2 cases, different paradigms lead to different treatment times (STEMI - NSTEMI vs. OMI - NOMI)

Nausea and Vomiting. This ECG is loaded with information.

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

PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

Chest pain with NonDiagnostic ECG but Diagnostic CT Scan

LVH with anterior ST Elevation. When is it anterior STEMI?

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

A young patient with diminishing pain with a subtle but diagnostic ECG.

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

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