Journal of the American Heart Association

JANUARY 31, 2024

BackgroundThe rapid evolution of artificial intelligence (AI) in conjunction with recent updates in dual antiplatelet therapy (DAPT) management guidelines emphasizes the necessity for innovative models to predict ischemic or bleeding events after drug‐eluting stent implantation.

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Stents Stent Innovation Ischemia 40

Med Page Today

APRIL 30, 2024

(MedPage Today) -- For patients with peripheral artery disease (PAD) and chronic limb-threatening ischemia, drug-eluting stents and drug-coated balloons did not improve amputation-free survival compared with balloon angioplasty alone in the BASIL.

Peripheral Arterial Disease 64

Peripheral Arterial Disease Angioplasty Heart Disease Cancer 64

Stroke Journal

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

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Stents Stent Stenosis Myocardial Infarction 40

Frontiers in Cardiovascular Medicine

JANUARY 10, 2024

Coronary heart disease is a narrowing or obstruction of the vascular cavity caused by atherosclerosis of the coronary arteries, which leads to myocardial ischemia and hypoxia. At present, percutaneous coronary intervention (PCI) is an effective treatment for coronary atherosclerotic heart disease.

Heart Disease 59

Heart Disease Stents Stent Atherosclerosis 59

Circulation

FEBRUARY 12, 2024

The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26–0.92])

Ultrasound 67

Ultrasound Myocardial Infarction Thrombosis Stents 67

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 111

Plaque Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

APRIL 14, 2024

No ischemia. This is a conundrum, because it is clear that the patient is having an acute MI, the ECG is dynamic, but the pain is very mild and there is no ECG evidence of active transmural ischemia. We already know that the ischemia is ongoing, though mild (because of the persistent pain). The culprit was opened and stented.

Chest Pain 107

Chest Pain Ischemia Myocardial Infarction Ultrasound 107

Dr. Smith's ECG Blog

JULY 30, 2023

The STD maximal in V1-V4 is diagnostic of acute transmural posterior wall ischemia, most likely due to posterior OMI. Subendocardial ischemia does not localize, and subendocardial ischemia presents with STD maximal in V5-6, II, and STE in aVR. Subendocardial ischemia does not localize. Finally the OMI was realized.

Chest Pain 52

Chest Pain Ischemia STEMI Arrhythmia 52

All About Cardiovascular System and Disorders

APRIL 10, 2024

IVUS Measurements Measurements include the measurement of lumen, plaque, calcium, remodeling, stent length and volumetric measurements. It can also give guidance for stenting in terms of assessment of stent apposition and good expansion. Incomplete stent apposition can be detected by intravascular ultrasound.

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Ultrasound Plaque Stents Stent 52

All About Cardiovascular System and Disorders

APRIL 21, 2024

indicates inducible ischemia while an FFR above 0.80 excludes ischemia in 90% of cases. If the FFR normalizes after stenting, the restenosis rates at six months is less than 5%. If the FFR normalizes after stenting, the restenosis rates at six months is less than 5%. Normal FFR is 1.0 and an FFR below 0.75 in the study.

Myocardial Infarction 52

Myocardial Infarction Coronary Artery Disease Stents Stent 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. First , there can simply be diffuse ST depressions (which obligates reciprocal STE in aVR) associated with tachycardia which are not indicative of ischemia.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

MAY 20, 2024

This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible.

Chest Pain 124

Chest Pain Blood Pressure Ischemia STEMI 124

DAIC

MARCH 20, 2024

The Freesolve BTK RMS is designed for individuals suffering from chronic limb-threatening ischemia (CLTI). Updated estimates for the burden of chronic limb-threatening ischemia in the Medicare population, Journal of Vascular Surgery, Volume 77, Issue 6, 2023, 1760-1775 2 Seguchi M., 2,3 It has shown 99.6%

Peripheral Arterial Disease 105

Peripheral Arterial Disease Innovation Coronary Artery Disease Technology 105

Coronary Artery Disease Journal

MARCH 7, 2024

Background Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44–0.83)

Myocardial Infarction 40

Myocardial Infarction Ischemia Thrombosis Stents 40

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 86

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 86

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 111

Heart Attack Heart attacks Peripheral Arterial Disease Ischemia 111

Dr. Smith's ECG Blog

MARCH 31, 2024

Angiogram reportedly showed acute thrombotic occlusion of the first obtuse marginal which was stented. non-occlusive ischemia) Ongoing ischemic symptoms in NSTEMI is already an indication for emergent cath, regardless of the ECG. Peak troponin was not recorded. The patient survived the hospitalization.

Chest Pain 91

Chest Pain STEMI Ischemia Myocardial Infarction 91

Frontiers in Cardiovascular Medicine

FEBRUARY 29, 2024

Outcome In the EVAR group, 47 patients (95.92%) were successfully implanted with overlapping stents, and 2 patients died in the perioperative period. In the TAAR group, 12 patients (92.31%) were successfully revascularized and 1 patient died in the perioperative period.

Aortic 49

Aortic Quality of Life Stents Stent 49

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. Nevertheless, the clinical situation made other etiologies unlikely.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Dr. Smith's ECG Blog

MAY 5, 2024

He interprets here: "This EKG is diagnostic of right bundle branch block and transmural ischemia of the anterior wall, most likely from an occlusion of the proximal LAD. There was a 100% proximal LAD occlusion that was opened and stented. It was recorded at 0530: What do you think? The young ED tech immediately suspected LAD OMI.

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EKG Technician Chest Pain Blog STEMI 113

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 99

Chest Pain Pacemaker Ischemia Stents 99

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

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Aneurysm Stroke Strokes Ischemia 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

In his four months follow up clinic visit he had no further concerns of recurrent strokes or new symptoms.ResultsCarotid stump syndrome is a rare cause of cerebral and retinal ischemia; however, it must be considered in patients with recurrent ischemic strokes and chronic ipsilateral ICA occlusion.

Stroke 40

Stroke Strokes Stents Stent 40

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. Of the patients, 60.5%

Aneurysm 40

Aneurysm Outcomes Hemorrhage Stents 40

EMS 12-Lead

APRIL 21, 2022

There is appreciable STE aVR with near-global STD that appropriately maximizes in Leads II and V5, and thus suggesting a circumstance of generic, diffusely populated, circumferential subendocardial ischemia versus occlusive coronary thrombus. [1] STEMI was activated and the patient went to Cath on arrival.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

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 74

AFIB Stents Stent Chest Pain 74

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 107

Chest Pain Cardiac Arrest Sudden Cardiac Death Stents 107

Dr. S. Venkatesan MD

FEBRUARY 25, 2024

It means either a percutaneous coronary intervention with a stent or CABG. Reference : Apart from the heavily quoted classics of COURAGE, BARI-2D, ISCHEMIA, ORBITA 1 etc. You may be. But I am not.You need to undergo some re-vascularisation procedure. What do you mean by that Doctor ? No we can’t.

Plaque 59

Plaque Chest Pain Stents Stent 59

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 40

Aneurysm Outcomes Hemorrhage Stents 40

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

Coronary Artery Disease 111

Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

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 111

Chest Pain Bradycardia STEMI Ischemia 111

Dr. Smith's ECG Blog

AUGUST 10, 2023

Even though they were passed the 12 hour mark traditionally associated with reperfusion benefits, ongoing ischemia requires emergent angiogram On assessment, the patient appeared uncomfortable, leaning forward in his chair. ACS with refractory ischemia and electrical instability are indications for emergent cath regardless of the ECG!

Chest Pain 86

Chest Pain STEMI Ischemia Nursing 86

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The patient was referred immediately for cath which revealed RCA occlusion that was stented. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There is ST depression in V1.

Ischemia 108

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 108

Dr. Smith's ECG Blog

JUNE 11, 2021

Similarly, STEMI guidelines call for urgent angiography for refractory ischemia or electrical/hemodynamic instability, regardless of ECG findings. So there is now high pre-test probability + refractory ischemia + Modified Sgarbossa + dynamic ECG changes. So the RCA was stented. Learning points 1.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

DAIC

MAY 30, 2024

The prospective, international, multicenter single-arm observational study evaluated the treatment of de novo, restenotic or occluded iliac lesions in 160 patients with Rutherford Class 2-6 peripheral artery disease using the Dynetic-35 cobalt chromium balloon-expandable stent system. At baseline, 12.5% stenosis in the target lesion.

Stents 69

Stents Stent Peripheral Arterial Disease Innovation 69

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. But no ECG met STEMI criteria so the patient was referred to cardiology as Non-STEMI.

STEMI 118

STEMI Chest Pain Myocardial Infarction Stents 118

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. Two stents were placed with resultant TIMI 3 flow. Overall, with return of pain and possible active posterior OMI, obviously we must consider this reocclusion until proven otherwise.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52