Abstract:

Aim: was to optimize treatment of patients with acute myocardial infarction without significant stenotic lesions of coronary arteries.

Materials and methods: authors present a clinical case of treatment of patient, who was admitted in few hours from onset of myocardial infarction. At first-stage, patient underwent manual vacuum thrombectomy, and it revealed the absence of significant stenotic lesions of coronary arteries. Patient underwent coronary angiography, left ventriculography, optical-coherence tomography of the infarct-dependent artery

Results: in this clinical case the cause of myocardial infarction in patient without significant stenotic coronary lesions was the presence of intramural fibrecalcific plaque without signs of instability

Conclusions: according to authors, in order to reduce the incidence of re-thrombosis of coronary arteries in patients with myocardial infarction without stenotic lesions of coronary arteries, it is recommended to perform optical-coherence tomography to reveal unstable atherosclerotic plaque; in such cases it may be warranted stenting of coronary artery.

References

1.      Sidel'nikov A.V., Chernysheva I.E., Koledinskij A.G.. Sravnitel'nyj analiz ehffektivnosti primeneniya tromboliticheskih preparatov: poisk prodolzhaetsya [Comparative analysis of efficacy of thrombolytic therapy: further search]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2014, 39:48-56 [In Russ].

2.      Chandrasekaran B., Kurbaan A. S. Myocardial infarction with angiographically normal coronary arteries. Journal of Royal Society of Medicine. 2002 Aug; 95(8): 398-400.

3.      Reynolds H. R. Myocardial infarction without obstructive coronary artery disease. Current Opinion in Cardiology. 2012, 27:655-660.

4.      Widimsky P., Stellova B., Groch L. et al. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies; on behalf of the PRAGUE Study Group Investigators. Can J Cardiol. 2006; 22(13): 1147-1152.

5.      Da Costa A., Isaaz K., Faure E. et al. Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients. Eur Heart J. 2001; 22(16): 1459-1465.

6.      Jamil G., Jamil M., Abbas A. et al. «Lone aspiration thrombectomy» without stenting in young patients with ST elevation myocardial infarction - Am J Cardiovasc Dis. 2013; 3(2):71-78.

7.      Escaned J, Echavarrna-Pinto M, Gorgadze T et al. Safety of lone thrombus aspiration without concomitant coronary stenting in selected patients with acute myocardial infarction. EuroIntervention. 2013;8: 1149-1156.

8.      Talarico G. P., Burzotta F., Trani C. et al. Thrombus Aspiration without Additional Ballooning or Stenting to Treat Selected Patients with ST-Elevation Myocardial Infarction. J Invasive Cardiol. 2010; 22(10): 489-492.

9.      Berger J.S., Elliott L., Gallup D. et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009; 302(8): 874-882.

10.    Dey S., Flather M.D., Devlin G. et al. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009; 95(1): 20-26.

11.    Roger V.L., Go A.S., Lloyd-Jones D.M. et al. Heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation. 2012; 125:e2-e220.

12.    Glagov S., Weisenberg E., Zarins C. et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987; 316: 1371-1375.

13.    Bentzon J. F., Otsuka F., Virmani R., Falk E. Mechanisms of Plaque Formation and Rupture. Circ Res. 2014; 114: 1852-1866.

14.    Shmatkov M.G., Morozova E.V. Opticheskaya kogerentnaya tomografiya: novye vozmozhnosti vnutrisosudistoj vizualizacii (obzor literatury) [Optical cpherence tomography: new possibilities of intravascular imaging (literature review)]. Diagnosticheskaya i intervencionnaya radiologiya, 2013, 7(4): 89-100 [In Russ] .

15.    Virmani    R., Burke A.P., Farb A., Kolodgie F.D. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006; 47: 13-18.

16.    Dhume A.S., Soundararajan K., Hunter W.J. III, Agrawal D.K. Comparison of vascular smooth muscle cell apoptosis and fibrous cap morphology in symptomatic and asymptomatic carotid artery disease. Ann Vasc Surg 2003; 17:1-8.

17.    Burke A.P, Farb A., Malcom G.T. et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997; 336: 1276-1282.

18.    Lam M. K., Sen H., Tandjung K. et al. Clinical Outcome of Patients With Implantation of Second-Generation Drug-Eluting Stents in the Right Coronary Ostium: Insights From 2-Year Follow-up of the TWENTE Trial/ Catheterization and Cardiovascular Interventions 2015; 85:524-531.

Abstract:

Aim: was to study immediate and medium-term results of using of stent Calypso in patients with acute coronary syndrome (ACS).

Materials and methods: 274 patients with ACS were included in study and were divided into 2 groups. The first group consisted of 140 patients, who underwent implantation of Calypso (Angioline, Russia). The other group consisted of 134 patients who underwent revascularization with further implantation of Xience (Abbot Vascular, USA). During first 24 hours after admission to the hospital all patients underwent percutaneous coronarography intervention (PCI). Their health state was monitored by phone during the 6, 9-12 months period. The majority of patients underwent coronary angiography during 9-12 months period.

Results: immediate results of the first group: incomplete stent apposition - in 0,6% cases, difficulties of delivery - in 3 cases, artery dissection - 2, occlusion of the side branch - 2 cases, acute thrombosis - 0,6% cases. Immediate results of the second group: incomplete stent apposition - in 0,5% cases, difficulties of delivery - in 2 cases, artery dissection - 2, occlusion of the side branch - 1 case, acute thrombosis - none. Confirmatory angiography in 9-12 months was done in 89 patients from the first group and 94 patients from the second group. The frequency of MACE in first group was 4,3%, in second group was 3,7%.

Conclusions: taking into consideration immediate and medium-term results it can be concludec that domestic stents can be successfully used in different clinical situations in different severity of lesions of coronary arteries. Calypso could be used in urgent PCI and they have minor percentage of complications in medium-term results.

 Reference 

1.     Chernjaev M.V., Koledinskij A.G. i dr. Koronarnye stenty: proshloe, nastojashhee, budushhee. Otechestvennye razrabotki v jendovaskuljarnoj hirurgii (obzor literatury). [Coronary stents: past, present, future. Domestic elaborations in endovascular surgery (literature review)]. Diagnosticheskaja i intervencionnaja radiologija. 2016; 10(4):51-56 [In Russ].

2.     Kudrjashov A.N., Lopotovskij P.Ju. Sravnitel'naja ocenka mehanicheskih svojstv koronarnogo stenta «Sinus». [Comparative estimation of mechanical properties of coronary stent «Sinus»]. Diagnosticheskaja i intervencionnaja radiologija.. 2014; 8(1)1:70-77 [In Russ].

3.     Lopotovskij P.Ju., Parhomenko M.V., Kokov L.S. Predvaritel'nye rezul'taty Registra retrospektivnogo issledovanija praktiki primenenija rossijskih stentov «Sinus» i «Kalipso». [Preliminary results of a retrospective study register for the use of Russian stents «Sinus» and «Calypso»]. Vestnik Roszdravnadzora. 2015; 5:44-49 [In Russ].