Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……

Postoperative adverse cardiac events in acute myocardial infarction with high thrombus load and best time for stent implantation

BACKGROUND Myocardial infarction is one of the most common types of coronary heart disease.It is mainly caused by the rupture of coronary atherosclerotic plaque,which leads to platelet agglutination and thrombosis.The occlusion of coronary arteries and vessels leads to insufficient myocardial blood supply,subsequently causing cardiac interstitial fibrosis,gradual enlargement of ventricles,and heart failure,which affects the quality of life and safety of patients.AIM To investigate the effects of emergency percutaneous interventional therapy(PCI)and delayed stenting in acute myocardial infarction with high thrombotic load and identify factors related to major adverse cardiovascular events(MACE).METHODS A total of 164 patients with acute myocardial infarction and high thrombotic load who received PCI were included.Of them,92 patients were treated with delayed stent implantation(delayed group)and 72 patients received emergency PCI(immediate group).Myocardial perfusion after stent implantation was compared between the two groups.Patients were followed up for 12 mo,and the occurrence of MACE was used as the endpoint.Univariate and multivariate models were used to analyze the factors affecting MACE occurrence.RESULTS After stent implantation,66(71.74%)patients in the delayed group and 40(55.56%)patients in the immediate group had thrombolysis in myocardial infarction(TIMI)flow grade 3(P<0.05),while 61(66.30%)patients in the delayed group and 39(54.17%)patients in the immediate group reached TIMI myocardial perfusion grade 3(P>0.05).MACE occurred in 29 patients.There were statistically significant differences between the MACE and non-MACE groups in diabetes rate,TIMI grading,stent implantation timing,intraoperative use of tirofiban,and the levels of white blood cells(WBC),neutrophils,red blood cell distribution width(RDW),and uric acid,and high-sensitivity C-reactive protein(hs-CRP)at admission(P<0.05).Logistic regression analysis showed that TIMI grade 3 and intraoperative use of tirofiban effectively reduced the risk of MACE(P<0.05),while immediate stent implantation,increased WBC,hs-CRP and RDW on admission increased the risk of MACE(P<0.05).CONCLUSION Delayed stent implantation outweighs emergency PCI in improving postoperative myocardial perfusion in acute myocardial infarction with high thrombotic load,and effectively reduces MACE in these patients.

Optical coherence tomography guided treatment avoids stenting in an antiphospholipid syndrome patient:A case report

BACKGROUND Increasing attention has been paid to acute myocardial infarction(AMI)in young female patients for whom secondary factors should be considered during the diagnostic process.Anti-phospholipid syndrome(APS),a rare autoimmune disease that is most common in young female patients,is reportedly related to AMI.To date,coronary interventions,particularly stenting,remains controversial in this special clinical scenario.CASE SUMMARY A 26-year-old female patient was admitted to hospital for acute chest pain,palpitations,and dyspnea.She had a past medical history of APS and pulmonary embolism.Coronary angiography showed acute occlusion of the proximal left anterior descending artery.After repeated thrombus aspirations,residual thrombus and mild stenosis were found in the proximal left anterior descending artery.Optical coherence tomography(OCT)was done,which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient.Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen.One week later,coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus.The 3-mo telephone follow-up reported a good prognosis.CONCLUSION APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients.Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.

Acute myocardial infarction after capecitabine treatment： not always vasospasm is responsible

Capecitabine is an orally available chemotherapeutic agent that is converted to 5-fluorouracil （5-FU） after absorbtion. Capecitabine and its active metabolite, 5-FU, have cardiotoxic effects with reported instances of acute coronary syndromes caused due to coronary vasospasm. However, these agents exert toxic effects on cardiovascular system and beyond vasospasm provacation. We report a 46-year-old patient diagnosed as acute inferior infarction who is treated with capecitabine for 3 months due to metastatic breast carcinoma, in whom thrombotic coronary occlusion was observed in angiography. This case demonstrates that apart from vasospasm, coronary thrombosis could be observed after capecitabine treatment, with a possible direct effect of this drug.