Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque 127

Plaque Angina Blog Stents 127

Circulation

NOVEMBER 11, 2024

A pathological classification of no-reflow was proposed: structural no-reflow—microvessels within the necrotic myocardium exhibit loss of capillary integrity (it is usually irreversible)—and functional no reflow—patency of microvasculature is compromised due to distal embolization, spasm, ischemic injury, reperfusion injury.

Ultrasound 40

Ultrasound Plaque Blood Pressure Myocardial Infarction 40

EMS 12-Lead

APRIL 9, 2024

Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates). This latter part has been implicated in embolic CVA. The underlying etiology is either Type 1 or Type II ischemia, although sometimes there’s overlap of both. Type I ischemia. Type II ischemia.

Ischemia 116

Ischemia Stenosis Chest Pain Coronary Artery Disease 116

Stroke Journal

FEBRUARY 1, 2024

Integration with carotid plaque data and diffusion coefficient analysis revealed shared transcriptional programs existing in a continuum, progressing from asymptomatic plaque to embolized thrombus.

Plaque 40

Plaque Embolism Strokes Stroke 40

Dr. Smith's ECG Blog

MAY 19, 2020

If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA. Here is my comment on MINOCA: "Non-obstructive coronary disease" does not necessarily imply "no plaque rupture with thrombus." They often cannot even be recognized as culprits, as fissured or ulcerated plaque. myocarditis).

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Circulation

NOVEMBER 11, 2024

Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved.

Aortic valve 40

Aortic valve TAVR Aortic Chest Pain 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

To prove there is no plaque rupture, you need to do intravascular ultrasound (IVUS). An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!! One of the most common is rupture of a non-obstructive plaque, with thrombus formation and OMI that spontaneously lyses and leaves a wide open artery. It can only be seen by IVUS.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Stroke Journal

FEBRUARY 1, 2024

We have developed a Proximal balloon Occlusion With forcEd aspiRation (POWER) technique to prevent distal embolization in CAS with the filter protection device. Purpose:Since the balloon protection device became unavailable in Japan three years ago, the DWI-positive rate after carotid artery stenting (CAS) has increased.

Stents 40

Stents Stent Stenosis Embolism 40

Stroke Journal

FEBRUARY 1, 2024

Background:Intracranial Atherosclerosis (ICAS) leads to stroke by perforator disease, artery to artery embolism, and impaired distal flow/perfusion. While medical treatment is likely to stabilize atherosclerotic plaques, it is unlikely to improve distal perfusion in the acute setting.

Atherosclerosis 40

Atherosclerosis Embolism Plaque Strokes 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

MRI at the time showed an acute embolic infarct in left MCA territory, and a CTA showed a sub‐occlusive thrombus vs. atherosclerotic plaque in the superior branch of the left MCA. His first stroke was preceded by about 1 week of intermittent confusion and right arm tingling.

Stroke 40

Stroke Strokes Embolism Plaque 40

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) Coronary Sinus Reducer for the Treatment of Refractory Angina: A Randomised, Placebo-controlled Trial (ORBITA-COSMIC) Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients at Low to Intermediate Risk: One Year Outcomes of the Randomized DEDICATE-DZHK6 Trial Effect of Alcohol-mediated Renal (..)

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Sanjay Gupta

DECEMBER 19, 2022

She had some very minor plaque but certainly nothing that could explain the heart attack and therefore she was discharged with a diagnosis of MINOCA i.e She agreed and we performed an angiogram and we were fully expecting a blockage but interestingly there weren’t any.

Heart Attack 40

Heart Attack Heart attacks Blood Clot Chest Pain 40

Dr. Smith's ECG Blog

MAY 10, 2023

LAD plaque with 0-25 percent stenosis. If there are T-wave inversions and elevated trops in the context of persistent pain, think of other pathologies such as pulmonary embolism. Now, with elevated troponins, Wellens' syndrome is likely. A CT Coronary angiogram was ordered. CAD-RADS category 1. --No Possibility #2: As per Dr.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JULY 11, 2018

Today, they viewed the angiogram and concluded that the thrombus at the mid RCA must have extended proximally from the culprit ruptured plaque, extending proximal to the RV marginal branch and temporarily occluding it. However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded.

Chest Pain 52

Chest Pain STEMI Ischemia Blog 52

Stroke Journal

JANUARY 24, 2025

BACKGROUND:A modified computed tomography angiography (CTA)based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke.

Plaque 40

Plaque Embolism Stroke Strokes 40

Stroke Journal

DECEMBER 28, 2023

BACKGROUND:Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS. Stroke, Ahead of Print.

Risk Factors 75

Risk Factors Plaque Embolism Stroke 75

Stroke Journal

DECEMBER 8, 2023

BACKGROUND:Aortic arch plaques are associated with an increased risk of ischemic stroke in patients with cryptogenic stroke or prior embolic events. Arch plaques were assessed by suprasternal transthoracic echocardiography; plaques ≥4 mm in thickness were classified as large plaques. Stroke, Ahead of Print.

Plaque 40

Plaque Aortic Stroke Strokes 40

DAIC

JUNE 4, 2024

The Neuroguard Integrated Embolic Protection (IEP) system is an experimental treatment for carotid artery stenosis, also known as carotid artery disease, a condition in which fatty-waxy deposits known as plaque builds up and blocks the normal flow of blood in the large arteries on either side of the neck.

Stents 111

Stents Stent Research Stroke 111

MIBHS

OCTOBER 31, 2024

Coronary Artery Disease (CAD) CAD, which involves the narrowing or blockage of coronary arteries due to plaque buildup, can reduce blood flow to the heart. Blood Clots: An enlarged heart is more prone to developing blood clots, which can lead to stroke or pulmonary embolism.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

All About Cardiovascular System and Disorders

MAY 22, 2024

About a fifth of all ischemic strokes are attributed to embolization of ruptured atherosclerotic plaque from carotid arterial stenosis. But it has been difficult to predict which person with asymptomatic carotid artery stenosis is likely to progress to symptomatic carotid disease and stroke.

Stenosis 52

Stenosis Stroke Strokes Risk Factors 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). CT angiogram showed extensive saddle pulmonary embolism.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion). This resulted in anterior/apical infarct and apical thrombus formation.

Chest Pain 64

Chest Pain Blog Arrhythmia Critical Care 64

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. No further troponins were measured. Serial chest xrays: progressive bilateral pulmonary edema. Diagnostic of Massive OMI.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

APRIL 13, 2025

The patient was found to have an embolic source. Provocative testing is very helpful for this Coronary Thrombus with lysis (one must do optical coherence tomography or at least intravascular ultrasound to find thes non-obstructive plaques that ruptured. Embolism with lysis. Need to find an embolic source.

Chest Pain 60

Chest Pain Embolism STEMI Plaque 60

Dr. Smith's ECG Blog

MARCH 1, 2025

Angiogram: --"Suspected culprit for the patient's non-ST elevation myocardial infarction with refractory chest discomfort (although it had resolved prior to arrival to the cardiac catheterization lab), is a ruptured plaque in the distal circumflex with local embolic occlusion of the distal OM 3."

Chest Pain 121

Chest Pain STEMI Stents Stent 121

Dr. Smith's ECG Blog

MARCH 25, 2025

And it is definitely possible that a more proximal LCx lesion ruptured and produced distal embolism. And in a study like COMPLETE or MULTISTARS AMI, you are stenting an acute plaque rupture (the culprit) and non-ruptured, non-culprit and hence essentially stable plaques. Some others worried about the RCA as a possible culprit.

Chest Pain 63

Chest Pain Ischemia Plaque Stents 63

Dr. Smith's ECG Blog

MARCH 8, 2025

Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. A distal RCA lesion ( blue arrow ), Delayed brisk filling of an initially occluded PDA due to a thrombus dislodged during injection which embolized distally. link] Bentzon, J.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75