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Stone, MD Mount Sinai Health System tim.hodson Wed, 04/02/2025 - 15:26 March 31, 2025 Using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures is safer and more effective for patients with severely calcified coronary artery disease than conventional angiography, the more commonly used technique.
In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity.
Smits and a distinguished team of international researchers, the trial compares the performance of SMT's biodegradable-polymer sirolimus-eluting Supraflex Cruz stent with the biodegradable-polymer Ultimaster Tansei * stent in patients with high bleeding risk (HBR) undergoing abbreviated dual antiplatelet therapy (DAPT).
The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stentthrombosis, and major adverse cardiac events. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction.
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.
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.
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)
I would expect TIMI-3 flow (normal flow, no persistent ischemia) with a culprit in the RCA (or possibly Circumflex). I would expect that a stent would be placed. The angiogram showed an open artery with 95% stenosis and thrombosis and it was stented. What would I expect the angiogram to show?
The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." It was stented. Comment: most T-wave inversion is nonspecific, but not these ones! Gottlieb SO, et al.
There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. A mid-LAD culprit lesion was identified and stented. References Naidu, S.
A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis. One stent was deployed with restorative TIMI-0 flow. The patient verbalized spontaneous improvement just before 324mg ASA administration. But the lesion is still active! However, when the Troponin I returned 8.4
Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. He was rushed to the Cath Lab where an LAD culprit lesion was stented. Here is the LAD after stent placement.
Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). It was thought to be an in stent restenosis and thrombosis from a DES placed in the same region 6 months prior. In there ECG evidence of possible ongoing ischemia? (ie,
After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all.
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