How to effectively manage the refractory coronary thrombus? A systemic mini-review

The main management principle for patients with coronary thrombus should be “more removal and less implantation”.Routine thrombus aspiration(TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus.It is unwise to implant a stent in the vessel with high residual thrombus,which is associated with no-reflow,impaired microvascular perfusion,and consequently worse clinical outcomes.Therefore,increasing the efficiency of TA during percutaneous coronary intervention procedures,especially under some conditions of refractory coronary thrombus,is very important to restore myocardial reperfusion and improve microvascular dysfunction early.In the present work,we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.

The balloon occlusion and thrombus aspiration catheter mediated-distal coronary perfusion technique(BI-RESCUE)for treatment of coronary artery perforation

Coronary artery perforation(CAP)remains an infrequent but potentially lifethreatening complication during percutaneous coronary intervention(PCI).Although the prevalence of CAP is about 0.2%−0.9%in relatively low risk PCI,the incidence could up to 9%in complex clinical scenarios such as severe coronary calcification,chronic total occlusions and rotational atherectomy.[1]Despite the new techniques and equipment had lower morbidity and mortality,up to 17%of acute CAP cases would evolve to tamponade and subsequent death.

Successful occluding by absorbable sutures for epicardial collateral branch perforation

In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.

Removal of refractory thrombus by 5F child catheter in patients with subacute myocardial infarction

No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that heavy thrombus burden could predict the development of no-reflow in PCI.Manual and mechanical thrombus aspiration catheters are widely used;however,there is still residual refractory thrombus left after the routine use of thrombectomy,especially in patients with subacute myocardial infarction(SMI).In our practice,child catheter aspiration has been used as a safe and effective approach to solve the residual thrombus in SMI patients.We described this technique in detail by a series of cases.

Intravascular ultrasound-guided “extended” reverse controlled antegrade and retrograde subintimal tracking technique using a cutting balloon for recanalizing chronic coronary total occlusion with a side branch

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.

A novel treatment of refractory coronary embolism:thrombus aspiration catheter-assisted twisting wire technique

Coronary embolism caused by the thrombus from guiding catheters is a rare and challenging complication,which may result in serious and fatal consequences due to the loss of blood flow of the coronary artery during percutaneous coronary intervention(PCI).Current strategies for the reduction of thrombus burden include pharmacological agents(typically glycoprotein IIb/IIIa platelet inhibitors),embolic protection devices(filters and distal balloon occlusion with aspiration),mechanical thrombectomy and manual or aspiration thrombectomy devices.[1]The above strategies are widely used as the first-line treatments,but have limitations for some refractory thrombus.A few techniques have been invented before to address this issue,[2–6]but they are not always effective or unavailable in some medical centers.

Effect of perindopril on the myocardial energy consumption in patients with heart failure after myocardial infarction

Objective:To explore the clinical efficacy of perinodopril in the treatment of heart failure in patients after myocardial infarction and effect on the myocardial energy consumption. Methods:A total of 87 patients with heart failure after myocardial infarction who were admitted in our hospital from August, 2014 to October, 2015 were included in the study and divided into the routine dose group (n=43, perinodopril 4 mg/d) and high dose group (n=44, perinodopril 8 mg/d) according to the long-term oral dose. All the patients were given perinodopril, continuously for 6 months. The changes of blood pressure and serum biochemical indicators before and after treatment in the two groups were compared. The changes of cardiac function indicators and myocardial energy consumption indicators before and after treatment in the two groups were compared. 6MWT 6 months and 1 year after treatment in the two groups was calculated.Results: The plasma BNP and H-FABP levels, LVEDD, LVESD, MEE, and cESS after treatment in the two groups were significantly reduced when compared with before treatment, and those in the high dose group were significantly lower than those in the low dose group. LVEF and FS after treatment in the two groups were significantly increased, and those in the high dose group were significantly greater than those in the routine dose group. The seurm potassium level after treatment in the high dose group was significantly elevated when compared with before treatment, but was not significantly different from that in the routine dose group. SBP, DBP, and Scr levels after treatment in the two groups were not significantly changed. 6MWT 6 months and 1 year after treatment in the high dose group was significantly greater than that in the routine dose group.Conclusions: Perinodopril in a high dose can significantly reduce the plasma BNP and H-FABP levels in patients with heart failure after myocardial infarction, inhibit the ventricular remodeling, promote the recovery of systolic function, reduce the myocardial energy consumption, and will not affect the blood pressure, serum potassium, and renal function, with efficacy significantly superior to that in a low dose;moreover, it has a certain safety.

Presence of Severe Stenosis in Most Culprit Lesions of Patients with ST-segment Elevation Myocardial Infarction

Background： Previous studies revealed that culprit vessels of ST-segment elevation myocardial infarction （STEMI） were often related to mild or moderate stenosis. However, recent studies suggested that severe stenosis was primarily found in culprit lesions. The objective of this study was to analyze the stenosis severity of culprit lesions in STEMI patients and to clarity the paradoxical results. Methods： A total of 489 consecutive STEMI patients who underwent primary percutaneous coronary intervention were retrospectively studied from January 2012 to December 2014. The patients were divided into three groups based on stenosis severity using quantitative coronary analysis： Group A, 314 cases, stenosis 〉70%： Group B, 127 cases, stenosis 50-70%： and Group C, 48 cases, stenosis 〈_50%,. The clinical, demographic, and angiographic data of all groups were analyzed. Results： Patients in Group A exhibited a significantly higher prevalence of history of angina pectoris （95.9% vs. 62.5%, P 〈 0.001 ）, inultivessel disease （73.2% vs. 54.2%, P = 0.007）, and lower cardiac ejection ITaction （53.3 ± 8.6 vs. 56.8 ± 8.4, P = 0.009） than those in Group C. Multivariable analysis revealed that history of angina pectoris （odds ratio [OR]： 13.89, 95% confidence interval [（7]： 6.21-31.11 ） and multivessel disease （OR： 2.32, 95%, CI： 1.25-4.31 ） were correlated with severe stenosis of the culprit lesion in Group A. Conclusions： Most culprit lesions in STEM[ patients were severe stenosis. These patients exhibited a higher prevalence of angina history and multivessel diseases.