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A 54-year old, hypertensive female patient underwent percutaneous coronary angioplasty (PTCA) followed by stenting of calcified chronic totally occluded right coronary artery. The post dilation balloon catheter got stuck and snapped during manipulations in inflated position within the stent, which could not be retrieved by nonsurgical interventions. Emergency surgery was performed to retrieve the stent along with an inflated balloon, followed by vein patch closure of arteriotomy and reversed saphenous vein graft anastomosis to right coronary artery and left anterior descending artery on cardiopulmonary bypass.

A 54-year old, hypertensive female patient underwent percutaneous coronary angioplasty (PTCA) followed by stenting of calcified chronic totally occluded right coronary artery. The post dilation balloon catheter got stuck and snapped during manipulations in inflated position within the stent, which could not be retrieved by nonsurgical interventions. Emergency surgery was performed to retrieve the stent along with an inflated balloon, followed by vein patch closure of arteriotomy and reversed saphenous vein graft anastomosis to right coronary artery and left anterior descending artery on cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Patients with right ventricular myocardial infarction (RVMI) and patients with. left ventricular myocardial infarction (LVMI) of the anterior wall with ST-elevation (STEMI), due to the profundity and volume of the necrosis, tend to have a more severe and more complicated clinical outcome as well as a higher mortality level compared to patients with myocardial infarction of inferoposterior localization in the left ventricle (IPILK), without the right ventricle being overtaken. C-Reactive protein (CRP) is a sensitive and reliable indicator of acute inflammation and is in good correlation with creatin kinasis (CK) or the enzymes which indicate necrosis markers in acute myocardial infarction (AIM). Because of this, a common biohumoral answer is of greater importance and more reliable both diagnostically and prognostically; it signifies a more severe and more complicated clinical outcome, especially on the rupture of the myocardium. The main goal of this study Was to compare the maximum values of enzymes and CRP in patients with RVMI and LVMI who had first STEMI and who were in the acute phase treated with percutaneous transluminal coronary angioplasty (PTCA). Methods. During a six-year period (2000-05), in the Clinic for Urgent Internal Medicine at the Military Medical Academy, a total of 74 patients included in a prospective study were divided into two groups. The first group consisted of patients with RMI 19 (25.67%), and the second group of patients with LMI 55 (74.33%). The patients in both groups received a percutaneous coronary intervention (PCI), if they had been admitted in the first 4 hrs from the beginning of the chest pain, and if there were no contraindications. All the others received thrombolitic therapy, and a "rescue" PCI if needed, in the next 24-48 hours. The risk factors, clinical outcome, necrosis and inflammation biomarkers (enzymes and CRP), coronary status, restenosis of stent, and intrahospital mortality rate in the first month, as well as a long term prognosis over a period of one year, were analysed. Results. The average age of the patients in the group with RVMI 19 (7 m + 12 f) was 66.1 ± 11y, and in the group with LVMI 55 (45 m + 10 f) 59.6 ± 13y, with a statistical trend which indicated that the patients with RVMI were older (66.1 ± 11y vs. 59.6 ± 13y, p < 0.061) and that women dominated (63.1% vs. 18.8%, p < 0.001). No statistical differences were found between the two groups of patients concerning the length and the appearance of the chest pain before admission to the hospital and the beginning of the PCI treatment, as well as risk factors such as smoking, cholesterol or diabetes. Of the total of 74 patients with the first STEMI as a primary manifestation of a coronary disease, we performed a primary PCI on 58 (78.37%), and a "rescue" PCI on 16 (21.63%) after the thrombolitic therapy during the 24-48h after admission. We had no cases of death either during the primary or the delayed PCI, or in the next 24h following the intervention. During the hospital phase of treatment, in the group with RMI the causes of death were the rupture of the free wall of the right ventricle (1), acute pancreatitis (1), ARDS and hypostatic pneumonia (1), cerebrovascular insult (1). During the following year, one more patient died due to reinfarction of the anterior localization. In the group with LMI, during the hospital phase of treatment 5 (9.09%) patients died: reinfarction (2), rupture of the left ventricle (1), respiratory insufficiency and severe hypostatic pneumonia (1), cerebrovascular insult (1). During the following year, 4 more patients died, sudden death (2), ischemic dilatative cardiomyopathy (2). The total mortality rate over a one-year period of observation in the group with LMI was 9 (16.3%), and in the group with RMI 5 (26.3%).… [ABSTRACT FROM AUTHOR]

Background: The use of intravenous glycoprotein IIb/IIIa—receptor antagonists has been shown to improve outcomes in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Tirofiban has shown benefit in a wide range of patients presenting with acute coronary syndromes. Although this agent has been used in patients undergoing percutaneous coronary intervention, a literature search identified no prospective data comparing tirofiban with placebo in patients undergoing planned intracoronary stent placement.Objective: This study examined the tolerability of tirofiban in patients undergoing percutaneous intervention with planned intracoronary stent placement.Methods: This was a multinational, multicenter, prospective, randomized, double-blind, placebo-controlled trial in patients scheduled to undergo PTCA with planned intracoronary stent placement. Patients were randomized in a 3:2 ratio to receive tirofiban as an intravenous bolus (10 μg/kg over 3 minutes) and maintenance infusion (0.10 μg/kg per minute for 36 hours) or a bolus and infusion of placebo. All patients received periprocedural aspirin and heparin and an optional postprocedural thienopyridine (ticlopidine or clopidogrel). Laboratory and safety monitoring were performed throughout the 36 hours after the procedure and at hour 40 or hospital discharge. The primary end point was the proportion of patients with bleeding, defined according to Thrombolysis in Myocardial Infarction (TIMI) trial criteria. The number of patients with cardiac events (death, myocardial infarction, urgent revascularization) during the first 30 days after stent placement was also assessed.Results: Eight hundred ninety-four patients (536 tirofiban, 358 placebo) were enrolled, all of whom received aspirin and heparin periprocedurally and optional ticlopidine or clopidogrel after the procedure. No significant between-group differences were observed in the incidence of TIMI major bleeding (0.2% tirofiban, 0.6% placebo) or any TIMI bleeding (3.2% and 1.7%, respectively). The incidence of TIMI minor bleeding was higher with tirofiban than with placebo (2.8% vs 0.6%). The 30-day incidence of the composite end point of any cardiac event was 3.9% in both groups.Conclusions: On a background of concomitant aspirin, heparin, and a thienopyridine, tirofiban was generally well tolerated in patients undergoing PTCA with planned intracoronary stent placement. Further investigation is needed to ascertain the optimal dosing of tirofiban and heparin to achieve reductions in ischemic complications of intracoronary stenting with an acceptable incidence of bleeding complications. [Copyright &y& Elsevier]

A 72‐year‐old asymptomatic woman with history of ischemic heart disease and repeat coronary percutaneous interventions underwent a routine transthoracic echocardiogram (TTE). A 9‐mm long, fixed, echo dense mass was visualized in the proximal ascending aorta. We performed a two and three‐dimensional transesophageal echocardiogram and a cardiac multidetector‐row contrast‐enhanced computed tomography with ECG gating, which revealed the unexplained mass to be an ostial right coronary artery stent protruding 9 mm into the ascending aorta. Coronary stent protrusion is a very unusual finding observed during routine 2DTTE, but it has many potential clinical consequences. This case suggests that 2DTTE is feasible and useful for the identification and follow‐up of protruding ostial coronary stents. [ABSTRACT FROM AUTHOR]