Jerome Jehl

Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging

BACKGROUND Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. AIMS To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. METHODS Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. RESULTS A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. CONCLUSION CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.

Radiofrequency Neurolysis in the Management of Inguinal Neuralgia: Preliminary Study

PURPOSE To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency (RF) neurolysis (RFN) in the management of refractory inguinal neuralgia. MATERIALS AND METHODS Local institutional review board approval was obtained and written informed consent was waived. Twelve patients 26-75 years of age with chronic (>6 months) inguinal pain refractory to specific medication were included between 2005 and 2011. Data on patient demographics, clinical history, and pain management history were retrospectively assessed. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after the procedure and at 1, 3, 6, 9 and 12 months. Diagnosis was always confirmed by a positive nerve block test result. Ambulatory CT-guided RF was the rule. RESULTS Sixteen RFN procedures were performed. Pain was present for an average of 3.2 years (range: 2-8 years) prior to initial RFN. Mean VAS score before the procedure was 7.75 of 10. Immediate pain relief of 100% was achieved in all patients. Pain reduction at 1-, 3-, 6-, 9-, and 12-month follow-up was statistically significant. Important pain reduction (≥80%) was obtained in 75% of RFN procedures at 6-month follow-up and in 50% of cases at 12 months. The mean duration of pain relief was 11.8 months after RFN, with a maximum average pain reduction of 84.5%. No complications were noted during or after the procedure. CONCLUSION RFN with CT guidance is an effective technique in the management of refractory inguinal pain with lasting satisfactory pain reduction; it may be considered as an alternative treatment to surgery. These results should be confirmed in a controlled trial with a larger series of patients.

006: Impact of successful thrombus retrieval during primary percutaneous coronary intervention with thrombus aspiration on the infarct size and microvascular obstruction: Insight from contrast-enhanced mag

Background hromboaspiration (TA) during primary percutaneous intervention (PPCI) is effective in opening the infarct-related artery in patients with ST-segment elevation myocardial infarction (STEMI), leading to better reperfusion and improved outcome. However, the effect of positive macroscopic efficiency of TA remains unknown. We aimed to evaluate the impact of positive thrombus retrieval during PPCI with manual TA on infarct size (IS) and microvascular obstruction (MVO) as assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) in a subset of patients with STEMI. Methods Inclusion criteria were patients aged Results 88patients were enrolled, mean age 55±10years; 43.1% in the positive TA group. Main results are presented in the table. Clinical and procedural characteristics (90-min total ischemic time, ST-segment resolution, post-procedural TIMI flow grade and post-stenting myocardial blush grade, and peak troponin) did not differ significantly between groups. Independent predictors of final IS were: positive TA (OR 0.34, 95%CI 0.03-0.71), MVO (OR 1.75, 95%CI 1.28-0.71) and IS at 5days (OR 2.06, 95%CI 1.87-3.32). Conclusion Positive thrombus retrieval during primary PPCI with manual TA in STEMI reduces MVO and in the acute phase and at 6 months and represents a powerful predictor of final infarct size. Table – Main results Negative TA (N=50) Positive TA (N+38) p MVO (%) 7.6±5.1 3.8±3.1 0.003 IS in the acute phase (%) 28.2±20.8 14.9±8.7 0.004 Final IS at 6 months (%) 22.3±19.3 12.0±8.3 0.002

TCT-468 Impact of Successful Thrombus Retrieval During Primary Percutaneous Coronary Intervention With Thrombus Aspiration on Infarct Size and Microvascular Obstruction: Insight From Contrast-Enhanced Magnetic Resonance Imaging

Thromboaspiration (TA) during primary percutaneous intervention (PPCI) is effective in opening the infarct-related artery in patients with ST-segment elevation myocardial infarction (STEMI), leading to better reperfusion and improved outcome. However, the effect of positive macroscopic efficiency of