The DEB-AMI Study is a 2-centre, randomised, open-label, 3-arm trial. Here, 150 patients with ST-elevation myocardial infarction (STEMI) receive either a bare-metal stent (BMS) plus a drug-eluting balloon (DEB) or a BMS alone or a drug-eluting stent (DES) alone after successful thrombosuction. A 52 year old man presented to the emergency department with an acute myocardial infarction (AMI) in February 2009. He had had chest pain for three hours prior to admission. His medical history was unremarkable except for smoking (25 pack years). He did not have any cardiovascular signs or symptoms prior to this event. To the knowledge of the authors, this report describes the first patient worldwide treated with a drug-eluting balloon during a STEMI with angiographic follow-up.
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A 76 year old female with symptoms and signs of an anterior NSTEMI initially received conservative medical treatment as there was no significant culprit disease on coronary angiography. Almost two months later, she re-presented with a further NSTEMI and a history of continued pain despite medical therapy. Further invasive evaluation of her coronary anatomy, with intravascular ultrasound, revealed plaque rupture extending from the distal left main stem to the ostium of the LAD. Attached to this area was a mobile thrombus which was successfully retrieved by simple aspiration. The patient settled well without the need for stent implantation.
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Successful recanalisation of coronary artery chronic total occlusion (CTO) can reduce the need for subsequent coronary artery bypass surgery and increase long-term survival. The retrograde approach through the collateral vessels, is considered one of the most promising and newly developed techniques in percutaneous coronary intervention (PCI) for CTO lesions. Here, we present a case report involving a patient with RCA CTO. Retrograde recanalisation from the distal left circumflex (LCX) artery to the PLB by using the bilateral transradial (TR) approach was successful, but resulted in creation of a false lumen in PDA during antegrade wiring. In order to rescue the PDA, a second retrograde procedure was performed from the distal left anterior descending (LAD) artery again under intravascular ultrasound (IVUS) guidance with final successful result.
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An 87 year old woman presented with chest pain four months after transcatheter aortic valve implant (TAVI) using the CoreValve® system. She had three similar attendances between TAVI implant and the index admission. Coronary angiography was possible through the stent struts of the nitinol frame and demonstrated a calcific embolus in the mid-right coronary artery which was not present on her pre-TAVI angiogram. This is thought to have been disrupted at the time of TAVI implant. The lesion was successfully crossed and stented. This case demonstrates that angioplasty of the right coronary artery is feasible following CoreValve® implantation.
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