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Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases

Stroke: Vascular and Interventional Neurology

OBJECTIVECarotid artery stenting for heavily calcified lesions is challenging for interventionists. Sufficient dilatation was achieved, followed by carotid stent deployment (Precise Pro RX; Cordis, Miami Lakes, FL, USA). Stroke: Vascular and Interventional Neurology, Ahead of Print.

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Abstract 190: Patient Selection for Intracranial Stenting: Impact on Clinical Outcomes and Procedural Success Rates

Stroke: Vascular and Interventional Neurology

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].

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A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.

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

Dr. Smith's ECG Blog

There’s competing sinus bradycardia and junctional rhythm, with otherwise normal conduction, borderline right axis, normal R wave progression and voltages. Cath lab was activated, and found a 95% proximal LAD occlusion which was stented. Significant bradycardia ( rate in the 40s/minute ) — is present throughout.

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Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

Former resident: "Just saw cath report, LAD stent was 100% acutely occluded." They of course opened and stented it. They said it looked similar to his old one (in my opinion, similar, but not similar enough to be able to say no OMI)." Smith : "What was the outcome?" You taught us well!"

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

Dr. Smith's ECG Blog

I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. preceding each of the fascicular beats — indicating a faster rate for the escape rhythm compared to the sinus bradycardia ).

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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

Case continued Another ECG was recorded 3 hours later, still 1/10 pain: There is sinus bradycardia with RBBB. The culprit was opened and stented. They only mask the underlying pathology. Aspirin and heparin were given, but no NTG. There is minimal STE in I and aVL, but this can be quite normal in RBBB.