Marcin Wizimirski

Assessment of Culprit Plaque Temperature by Intracoronary Thermography Appears Inconclusive in Patients With Acute Coronary Syndromes

Objective—Safety and feasibility evaluation of intracoronary temperature measurements in patients with acute coronary syndromes (ACS) using a catheter based thermography system. Methods and Results—Thermography was performed in 40 patients with ACS. A 3.5-F thermography catheter containing 5 thermocouples measuring vessel wall temperature, and 1 thermocouple measuring blood temperature (accuracy 0.05°C) was used. Gradient (&Dgr;Tmax) between blood temperature (Tbl) and the maximum wall temperature during pullback was measured. The device showed satisfactory safety in ACS. Only in 16 patients (40%) &Dgr;Tmax was ≥0.1°C. In 23 patients (57.5%) the highest &Dgr;Tmax was found in the culprit segment. &Dgr;Tmax between culprit and adjacent non-culprit segments was observed in patients with transient blood flow interruption during thermography (0.11±0.03 versus 0.08±0.01; P=0.04), in contrast to patients with preserved flow (0.07±0.03 versus 0.06±0.02; P=0.058). Conclusions—The novel, technically sophisticated intracoronary thermography proved its safety and feasibility. However, we were not able to convincingly and consistently differentiate between different lesions at risk, despite a selection of lesions that should appear most distinct to differentiate. A systematic interruption of flow may be necessary to achieve diagnostic results consistently, although such requirement may unfavorably change the risk-to-benefit ratio of this developing technology.

Virtual Histology-Intravascular Ultrasound Assessment of Lesion Coverage After Angiographically-Guided Stent Implantation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

An occlusion or severe stenosis (angiographic culprit lesion) of the infarct-related artery is frequently located at the site of the maximum thrombus burden, whereas the origin of the plaque rupture (the true culprit) can be situated proximal or distal to it. The aim of this study was to examine stent coverage of true culprit lesions in 20 patients who underwent primary percutaneous coronary intervention and had Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow restored in the infarct-related artery by angiographically guided direct stenting. Images of lesions were obtained using virtual histology-intravascular ultrasound before and after intervention (blinded to the operator). Plaque rupture sites were identified by intravascular ultrasound in 12 lesions (60%), 11 proximal and 1 distal to the minimum luminal area (MLA). Maximum necrotic core sites were found proximal to the MLA in 16 lesions, at the MLA in 3 lesions, and distal to the MLA in 1 lesion. Plaque rupture sites were fully covered by stents in 11 lesions. Virtual histology-intravascular ultrasound-derived thin-cap fibroatheroma longitudinal geographic misses were found in 10 lesions, 7 in the proximal reference segment and in 3 patients in the proximal and distal reference segments. In conclusion, in about 50% of patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction with optimal angiographic results, the stent does not fully cover the maximum necrotic core site related to the culprit lesion.

Rescue removal of disrupted balloon catheter from right coronary artery and aortic arch

We present the case of a 70-year-old female patient diagnosed with unstable angina, who was qualified to coronarography in a peripheral interventional cardiology department. Critical stenosis of right posterior descending artery was found. During percutaneous coronary intervention, after-stent balloon catheter interrupted and was left partially in the right coronary artery sticking out of the aortic arch. In a second attempt at removal, using an Amplatz GooseNeck snare, operators managed to take the broken balloon out of the intravascular space.