Mladen Tasic

Coronary spasm that caused non-ST elevation myocardial infarction appeared in cath lab due to vasovagal reaction.

Coronary artery spasm is sometimes an unrecognized cause of myocardial ischemia. Myocardial ischemia is not always a product of fixed stenosis; it can also be induced by dynamic, transient stenosis. The angiogram represents the current state of vasculature at the time of examination and absence of stenosis does not mean disease absence. We present a case of right coronary artery spasm that caused non-ST elevation myocardial infarction and arrhythmias and was induced again in the cath lab due to vasovagal reaction.

Knuckle technique guided by intravascular ultrasound for in-stent restenosis occlusion treatment

One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion.

Identifying culprit lesions in non-ST-elevation myocardial infarction: are new diagnostic tools always better?

Address for correspondence: Dr Miodrag J. Sreckovic, Clinical Centre Kragujevac, Interventional Cardiology, Faculty of Medical Sciences, Kragujevac, Serbia, tel: 381693371777, e-mail: sreckovic7@gmail.com Conflict of interest: none declared Kardiologia Polska Copyright

Efficacy And Safety Of IVUS-Guided Percutaneous Coronary Interventions

Abstract The inclusion of IVUS-guided PCI has yet to become a routine approach in invasive cardiology due to the relatively high cost of the procedure, equivocal positive results in important studies and the steep learning curve. As an additional diagnostic tool, IVUS seems to be irreplaceable in stent apposition research, edge dissections and the determination of plaque composition. To examine the efficacy and safety of IVUS-guided PCI vs. angiographically guided PCI in a centre without prior experience. A total of 35 patients were examined using IVUS prior to stent placement, and the gathered data were used to determine adequate implanted stent size and length. The acquired parameters were as follows: percentage of stenosis, MLD, CSA and distal reference diameter. After PCI, IVUS studies were repeated and data on the CSA, residual stenosis and MLD were acquired. Additionally, stent size and length, deployment pressure and the use of additional post-dilatations were recorded. There were 35 patients with similar demographic data in the control group who underwent treatment of the same vessel segment with the same stent type. Additional data regarding acute complications (dissections, slow flow during or after the procedure, IM) were obtained from the existing database and complications after six months, such as the need for TVR, MACE and death, were also obtained. Significant differences were observed in terms of stent size and length, residual stenosis, post-dilatation and MLD in favour of the IVUS group; in addition, TVR was 36% lower in the IVUS group with no significant difference in MACE and death between the groups. After introduction of the method, IVUS-guided PCI exhibited reasonable safety and efficacy compared to conventional angiographically guided PCI at centres without prior experience.

Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

ABSTRACT Coronary perforations are rare but vicious complications of PCI procedures. Ellis type III coronary artery perforation represents the most severe form and demands an urgent solution. It is often necessary to perform pericardiocentesis and utilizise multiple interventional techniques to seal the perforation. Polytetrafluoroethylene (PTFE)-covered stent implantation has become one of the most frequently used percutaneous solutions, but disadvantages of this intervention are its high profile and low device flexibility. In our case, we attempted to improve the deliverability of the PTFE stent graft alone by mounting it on a bare metal stent used as a stent graft carrier. SAŽETAK Koronarne perforacije su retke ali izuzetno neugodne komlikacije perkutanih intervencija. Perforacije koronarnh arterija trećeg stepena po Elisu predstvaljaju najozbiljniju formu perforacija i zahtevaju hitno zbrinjavanje. Često je neophodno uraditi perikardiocentezu i primeniti brojne interventne tehnike kako bismo rešili perforaciju. Stentovi prekriveni politetrafluoroetilenom(PTFE) postali su jedno od najčešće korišćenih perkutanih rešenja, ali su njihove mane visoki profil i slaba fleksibilnost. U našem slučaju, pokušali smo da poboljšamo plasiranje PTFE stenta montiranjem na metalni stent, koji smo iskoristili kao nosač.

Efficiency of IVUS guided procedures in center without previous experience

Introduction of IVUS procedures in the routine practice is not yet achieved nor there are significant studies that dealt with examining the success of IVUS guided PCI, showed a significant advantage over conventional angiography guided PCI. On the other hand a number of smaller studies give results for the benefit of IVUS. The aim of the research is to check the effectiveness of IVUS guided PCI in the center with no previous experience in performing intravascular ultrasound diagnostics.