Intravascular Ultrasound– Guided Percutaneous Coronary Intervention:An Updated Review

Common practice dictates the performance of percutaneous coronary intervention under conventional angiographic guidance.With studies suggesting the high incidence of intraobserver variability,especially in angiographic borderline lesions,new modalities such as intravascular ultrasound(IVUS)guidance during percutaneous coronary intervention have surfaced.Multiple studies have shown improved outcomes with IVUS guidance,mainly driven by a decrease in ischemia-driven target lesion revascularization.In the past two decades,a multitude of studies have investigated the uses and clinical outcomes associated with this technology.In this review,we highlight the utility,advantages,economic implications,and clinical outcomes of IVUS guidance over standard angiographic guidance,with emphasis on data as they pertain to IVUS-guided stent implantation.

Cardiovascular Abnormalities Among Patients with Spontaneous Subarachnoid Hemorrhage.A Single Center Experience

Objective:To assess the cardiovascular abnormalities in patients with spontaneous subarachnoid hemorrhage(SAH).Methods:All patients admitted to our institution with a primary diagnosis of spontaneous SAH and had a transthoracic echocardiogram(TTE)performed from 1st of July 2011 until 30th of May 2014 were enrolled.Results:Out of 2058 patients admitted to our institution with a diagnosis of SAH,over a three year period,only 244 patients(12%) had TTE performed during the index hospitalization.In this selected cohort,the mean age was 59 years and 66% of patients were female.Elevated troponin T was noticed in 37% of patients and QTc prolongation was the commonest ECG abnormality occurring in 49% of the patients.Thirty nine patients(16%) had a resting segmental wall motion abnormality on the TTE,including fi ve patients with apical ballooning.In-hospital mortality was 15.6% (38 patients).Conclusion:Cardiovascular abnormalities in selected patients with SAH who had cardiac ultrasound are relatively common;however the incidence of ventricular ballooning is low.In order to attain the correct incidence of cardiovascular abnormalities in SAH patients,all patients admitted with SAH should undergo TTE and have ECG and cardiac markers checked during their hospitalization.

Current Considerations of Thrombectomy for Acute Myocardial Infarction

Management of thrombus in coronary lesions remains a challenge that is frequently encountered during primary percutaneous coronary intervention(PCI)for ST-elevation myocardial infarction(STEMI)and is usually associated with poor clinical outcomes.At the same time,the optimum management of such lesions remains a dilemma.Multiple thrombus removal procedures have emerged with the short-term aim of improving myocardial perfusion and a longer-term aim of decreasing the incidence of both major adverse cardiac events(MACE)and all-cause mortality.In this review,we will highlight the main procedures utilized for thrombus removal during primary PCI for STEMI,with particular emphasis on aspiration thrombectomy.We will also approach possible theories that might explain the apparent lack of clinical benefit recently shown with such procedures.