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Introduction. Congenital coronary anomalies are detected in about 5% of all performed coronarographies. Coronary artery (CA) anomalies (CAA), considered to be of great risk, are the ones where the CA arises from the opposite sinus (anomalous origination of CA from opposite sinus, ACA-OS) of Valsalva. These anomalies are detected in about 1% of cases. This report shows a unique case of a patient with anterior wall ST-elevation myocardial infarction (STEMI) caused by left main CA (LMCA) occlusion, which arose from the right coronary cusp and had an interarterial course, successfully treated with primary percutaneous coronary intervention (PCI). Case report. A 46-year-old male patient was admitted to the hospital due to STEMI of the anterior region. On admission, the patient was hypertensive (150/100 mmHg) in sinus rhythm (heart rate 70/min), Killip I. After the initial examination and admitting dual antiplatelet therapy, the patient underwent urgent coronarography. Coronarography was performed using the transradial approach. The right CA had no significant stenosis and was easily cannulated, whereas the left CA could not be cannulated at the usual position. Attempts to cannulate the left CA with multiple catheters of various curves were unsuccessful. The conclusion was that there was a CA anomaly, and the cannulation of the anomalous left CA, which arose from the opposite (right) coronary cusp (anomalous aortic origin of the left CA, AAOLCA), was successfully performed with a Multipurpose catheter. Moreover, the LMCA was occluded in the distal segment. Two drug-eluting stents (DES) were implanted, but the patient developed the no-reflow phenomenon and cardiogenic shock. After the patient was stabilized, computed tomography (CT) coronarography was performed, and AAOLCA with an interarterial course was registered. During the follow-up period, single photon emission computed tomography (SPECT) was per-formed, and in the staged procedure, a stent was implanted into the proximal circumflex artery using the T and protrusion (TAP) technique. Conclusion. Patients with STEMI and the anomalies of CAs are very rare. As such, these patients represent a great challenge for revascularization. Possessing the knowledge of anatomic varieties is paramount when it comes to these patients to treat them adequately with primary PCI.

Introduction/Aim. The most important clinically relevant cause of global cerebral ischemia is cardiac arrest. Clinical studies showed a marked neuroprotective effect of mild hypothermia in resuscitation. The aim of this study was to evaluate the impact of mild hypothermia on neurological outcome and survival of the patients in coma, after cardiac arrest and return of spontaneous circulation. Methods. The prospective study was conducted on consecutive comatose patients admitted to our clinic after cardiac arrest and return of spontaneous circulation, between February 2005 and May 2009. The patients were divided into two groups: the patients treated with mild hypothermia and the patients treated conservatively. The intravascular in combination with external method of cooling or only external cooling was used during the first 24 hours, after which spontaneous rewarming started. The endpoints were survival rate and neurological outcome. The neurological outcome was observed with Cerebral Performance Category Scale (CPC). Follow-up was 30 days. Results. The study was conducted on 82 patients: 45 patients (age 57.93 ± 14.08 years, 77.8% male) were treated with hypothermia, and 37 patients (age 62.00 ± 9.60 years, 67.6% male) were treated conservatively. In the group treated with therapeutic hypothermia protocol, 21 (46.7%) patients had full neurological restitution (CPC 1), 3 (6.7%) patients had good neurologic outcome (CPC 2), 1 (2.2%) patient remained in coma and 20 (44.4%) patients finally died (CPC 5). In the normothermic group 7 (18.9%) patients had full neurological restitution (CPC 1), and 30 (81.1%) patients remained in coma and finally died (CPC 5). Between the two therapeutic groups there was statistically significant difference in frequencies of different neurologic outcome (p = 0.006), specially between the patients with CPC 1 and CPC 5 outcome (p = 0.003). In the group treated with mild hypothermia 23 (51.1%) patients survived, and in the normothermic group 30 (81.1%) patients died, while in the group of survived patients 23 (76.7%) were treated with mild hypothermia (p = 0.003). Conclusion. Mild therapeutic hypothermia applied after cardiac arrest improved neurological outcome and reduced mortality in the studied group of comatose survivors.

Background/Aim. Inflammation plays a key role in the physiopathology of arteriosclerosis. C-reactive protein (CRP) and common carotid artery intima-media thickness are independent predictors of cardiovascular events and diabetes mellitus in apparently healthy men, but relationship between them is not fully elucidated. The aim of the study was to assess the cross-sectional relationship between CRP and cardiovascular risk factors with common carotid artery intima-media thickness in military pilots as representatives of healthy men. Methods. We studied 161 military pilots (age 38 ± 6 years) free of cardiovascular disease and diabetes mellitus. Traditional and metabolic risk factors were determined. Plasma CRP was measured by immunonephelometry. The common carotid artery intima-media thickness was measured by ultrasonography in the posterior wall of both common carotid arteries. Results. A total of 66.5% subjects had common carotid artery intima-media thickness > 0.9 mm (p < 0.01). The mean CRP plasma concentration was significantly higher in the subjects with common carotid artery intima- media thickness > 0.9 mm than in those with common carotid artery intima-media thickness ≤ 0.9 mm. In a simple regression analysis age adjusted CRP was associated with common carotid artery intima-media thickness (β = 0.285, p < 0.01), and only high density lipoprotein cholesterol was not associated with common carotid artery intima-media thickness. The association between CRP and common carotid artery intima-media thickness remained highly significant after controlling for body mass index, blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, glycosylated hemoglobin and smoking (p < 0.01). Controlling for glucose, triglycerides to high density lipoprotein cholesterol ratio, and total cholesterol to high density lipoprotein cholesterol ratio resulted in some reduction in the strength of the association, but including waist circumference in the regression made the relationship no longer significant (p = 0.119). Body mass index (β = 0.352; p < 0.01), total cholesterol to high density lipoprotein cholesterol ratio (β = 0.334; p < 0.01) and age (β = 0.190; p = 0.036) were the independent predictors of common carotid artery intima-media thickness. Conclusions. In the studied group of healthy men CRP per se is not an independent predictor of early arteriosclerosis, and may mediate the effect of certain traditional risk factors, especially visceral obesity, on promoting aterogenesis.

Background/Aim. Inflammation plays a key role in the physiopathology of arteriosclerosis. C-reactive protein (CRP) and common carotid artery intima-media thickness are independent predictors of cardiovascular events and diabetes mellitus in apparently healthy men, but relationship between them is not fully elucidated. The aim of the study was to assess the cross-sectional relationship between CRP and cardiovascular risk factors with common carotid artery intima-media thickness in military pilots as representatives of healthy men. Methods. We studied 161 military pilots (age 38 ± 6 years) free of cardiovascular disease and diabetes mellitus. Traditional and metabolic risk factors were determined. Plasma CRP was measured by immunonephelometry. The common carotid artery intima-media thickness was measured by ultrasonography in the posterior wall of both common carotid arteries. Results. A total of 66.5% subjects had common carotid artery intima-media thickness > 0.9 mm (p < 0.01). The mean CRP plasma concentration was significantly higher in the subjects with common carotid artery intima- media thickness > 0.9 mm than in those with common carotid artery intima-media thickness ≤ 0.9 mm. In a simple regression analysis age adjusted CRP was associated with common carotid artery intima-media thickness (β = 0.285, p < 0.01), and only high density lipoprotein cholesterol was not associated with common carotid artery intima-media thickness. The association between CRP and common carotid artery intima-media thickness remained highly significant after controlling for body mass index, blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, glycosylated hemoglobin and smoking (p < 0.01). Controlling for glucose, triglycerides to high density lipoprotein cholesterol ratio, and total cholesterol to high density lipoprotein cholesterol ratio resulted in some reduction in the strength of the association, but including waist circumference in the regression made the relationship no longer significant (p = 0.119). Body mass index (β = 0.352; p < 0.01), total cholesterol to high density lipoprotein cholesterol ratio (β = 0.334; p < 0.01) and age (β = 0.190; p = 0.036) were the independent predictors of common carotid artery intima-media thickness. Conclusions. In the studied group of healthy men CRP per se is not an independent predictor of early arteriosclerosis, and may mediate the effect of certain traditional risk factors, especially visceral obesity, on promoting aterogenesis. [ABSTRACT FROM AUTHOR]

Introduction Late stent thrombosis is a serious complication after stent implantation and it can lead to the devolpment of acute myocardial infarction or death. A case report A 43-year-old patient was admitted to our clinic to coronary care unit. He was diagnosed with acute ST elevation myocardial reinfarction of inferoposterior localisation and with right ventricular myocardial infarction. Eighteen months ago, he had acute myocardial infarction of the same localisation, and at the same time,PCI (Percutaneous Coronary Intervention) was performed in acute phase, and two bare metal stents were implanted. Now, the patient had chest discomfort two hours before admittance, and PCI was performed once again in acute phase. The diagnostic coronarography resulted in occlusion of the right coronary artery, on the spot of the previously implanted stents. After the passage of guidewire, the artery was recanalized, and defects of artery opacification, which might have been thrombs, were noticed. The thrombs were seen on the spots of earlier implanted stents and in the posterior inteventricular and posterolateral branches of the right coronary artery. PTCA was performed and the patient received the GP IIb/IIIa antagonist therapy after which the control coronarography showed minimal defects of artery opacification, with good anterograde flow. After complete treatment the patient was in good condition. Conclusion Late stent thrombosis, although not very often, is a very serious complication and can lead to death or acute myocardial infarction. To prevent it, it is necessary that the patient receives dual antiplatelet therapy, and that PCI procedure is performed technically correctly (suitable stent dimensions and proper stem expansion). [ABSTRACT FROM AUTHOR]

Introduction. The single most important clinically relevant cause of global cerebral ischemia is cardiac arrest. The estimated rate of sudden cardiac arrest is between 40 and 130 cases per 100.000 people per year. Almost 80% of patients initially resuscitated from cardiac arrest remain comatose for more than one hour. One year after cardiac arrest only 10–30% of these patients survive with good neurological outcome. The ability to survive anoxic no-flow states is dramatically increased with protective and preservative hypothermia. The results of clinical studies show a marked neuroprotective effect of mild hypothermia in resuscitation. Material and Methods. In our clinic, 12 patients were treated with therapeutic hypothermia. A combination of intravascular and external method of cooling was used according to the ILCOR (International Liaison Committee on Resuscitation) guidelines. The target temperature was 33°C, while the duration of cooling was 24 hours. After that, passive rewarming was allowed. All patients also received other necessary therapy. Results. Six patients (50%) had a complete neurological recovery. Two patients (16.6%) had partial neurological recovery. Four patients (33.3%) remained comatose. Five patients (41.66%) survived, while 7 (58.33%) patients died. The main cause of cardiac arrest was acute myocardial infarction (91.6%). One patient had acute myocarditis. Conclusion. Mild resuscitative hypothermia after cardiac arrest improves neurological outcome and reduces mortality in comatose survivors. [ABSTRACT FROM AUTHOR]

Introduction After occlusion or subocclusion of the blood vessels, myocardial perfusion is maintained through the collateral vessels. There are two mechanisms of vessel formation: arteriogenesis and angiogenesis. The term arteriogenesis describes the growth of the existing collaterals into mature arteries. On the other hand, angiogenesis, is a process of developing new blood vessels from the preexisting ones. Collateral blood vessels have many functional roles. If they are adequately developed, they can protect the myocardium from ischemic injury. Even when a total occlusion develops, regional left ventricular motility is better in segments with developed collateral circulation. In patients with well-developed collaterals, who experience coronary artery occlusion, often there is no evidence of myocardial infarction in the area of the occluded artery. Well-developed collaterals reduce the risk of unstable cardiac events. Case report A case of right coronary artery occlusion with good collateral circulation and preserved myocardial left ventricular motility is presented. After coronary stent implantation, the patient was asymptomatic, and the maximal stress test for myocardial ischemia was negative. Conclusion Despite coronary vessel occlusion, collateral blood flow maintains the pump function of the left ventricle. [ABSTRACT FROM AUTHOR]