A 48-year-old man with acute coronary syndrome was transferred to our hospital for primary percutaneous coronary intervention. He underwent urgent balloon angioplasty for in-stent restenosis in the distal right coronary artery (RCA) and drug-eluting stent implantation (4.0 × 33 mm) across the coronary artery aneurysm (CAA) in the mid RCA (Fig. 1a, the upper panels). Subsequently, procedure to exclude CAA was intended since the CAA was proven to be enlarged within three years by referring previous angiogram. While shortest length of the covered stent (CS) available in Japan at that moment was 16 mm, the distance between two right ventricular branches (RVBs) originating at proximal and distal sides of the CAA was 13.4 mm on optical coherence tomography (OCT) (Fig. 1a, the lower panels). Angiogram also demonstrated a 4.0 × 16 mm CS (GRAFTMASTER, Abbott Vascular) would jail at least one RVB (Fig. 1b, the upper left panel, a white dotted line). Accordingly, implantation with high pressure (20 atm) and post-dilatation with a 5.0-mm non-compliant balloon (22 atm) was performed to cause intentional shortening of the CS, the degree of which was reported to be potentially approximately 3 mm using larger balloons [1]. Consequently, CAA was excluded with preserved flow into both RVBs (Fig. 1b, the upper right panel) and the implanted CS was shortened by 3.0 mm on OCT (proximally 1.4 mm and distally 1.6 mm in length, Fig. 1b, the lower panels). The edge injury related to the CS implantation with high pressure was successfully avoided, thanks to the first stent, the length of which was longer than that of the CS, as a previous report suggested [2]. At the 10-month follow-up, he had been symptom free. The patency of both RVBs, absence of CAA, and shortened CS without restenosis were also confirmed by coronary computed tomography.
Fig. 1
Successful Exclusion of CAA. The findings of angiogram are shown in the upper panels and those of optical coherence tomography (OCT) in the lower panels. A Pre-procedural assessment indicated the risk of RVBs (right ventricular branches) occlusion. a White asterisk indicates distal end of the ostium of distal RVB. b Deployed DES (drug-eluting stent) across the CAA (coronary artery aneurysm). c White asterisk indicates proximal end of the ostium of proximal RVB. B Successful CS (covered stent) implantation. a’ Distal overlap of CS (covered stent) and DES. b’ CS on deployed DES across the CAA. c’ Proximal overlap of CS and DES
Wie gebrechlich jemand ist, entscheidet offenbar wesentlich darüber, ob und wie gut er/sie eine Herzoperation übersteht. In einer Studie aus Michigan ging ein Punktwert von 5 oder höher auf der CFS (Clinical Frailty Scale) mit einer signifikant höheren Mortalität und Morbidität einher.
SGLT2-Hemmer waren in Beobachtungsstudien mit einem niedrigeren Risiko für Vorhofflimmern assoziiert. Könnte dies auf direkte antiarrhythmische Effekte zurückzuführen sein? Aufschluss darüber sollte die randomisierte DARE-AF-Studie geben.
Die meisten Patienten mit Vorhofflimmern erhalten in Deutschland nach einer perkutanen Koronarintervention eine leitliniengerechte antithrombotische Therapie. Die orale Antikoagulation entfällt aber bei bis zu 12%, die Thrombozytenhemmung bei bis zu 20%.
Ein nachlassender Geruchssinn könnte ein Hinweis auf ein erhöhtes Risiko für die koronare Herzkrankheit (KHK) sein. In einer Analyse von über 5.000 älteren Erwachsenen war die Assoziation in den ersten Jahren nach Testung am stärksten und nahm mit der Zeit ab.
In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.
