Very late bare metal stent thrombosis presenting with acute myocardial infarction: 14 years after coronary stenting.

Fourteen years previously, a 67-year-old man underwent percutaneous coronary intervention (PCI) for proximal left anterior descending artery lesion with a bare metal stent (BMS) for acute myocardial infarction (AMI) and attained an excellent result. Ticlopidine (200 mg) was administered for one month and 100 mg of aspirin was daily has been continued. One year after PCI, coronary angiography showed no restenosis. However, 14 years after PCI, he suffered from AMI due to stent thrombosis. Intracoronary aspiration thrombectomy and implantation of a drug-eluting stent were successful. This report demonstrates evidence of a very late case of stent thrombosis with the use of BMS.

Balloon rupture during coronary angioplasty causing dissection and intramural hematoma of the coronary artery; a case report.

A 73-year-old male with diabetes mellitus was referred for coronary angiography (CAG). He presented with stable effort angina pectoris. CAG showed a significant stenotic lesion in the proximal-segment of the left anterior descending (LAD) coronary artery with heavy calcification. He then underwent angioplasty for the LAD stenosis. On the second balloon dilatation, the balloon was inflated to 22 atm, at which point the balloon waist had not yet yielded and balloon rupture occurred. Immediately after the procedure, CAG showed no-reflow phenomena and chest pain occurred. Intravascular ultrasound (IVUS) imaging revealed a dissection into the media with extension into the medial space without reentry, and demonstrated significant stenosis and obstruction of the distal LAD with a semilunar echo-dense intramural hematoma. To bail out, two bare metal stents were deployed. After the procedure, proper stents expansion and no residual dissection flap were detected either by IVUS or CAG. The final CAG showed a good result with TIMI-3 coronary flow. This case highlights balloon rupture during coronary angioplasty with heavy calcification caused no-reflow phenomena by dissection and intramural hematoma of the coronary artery. We could bail out hematoma by coronary stent implantation with complete cover of the coronary dissection.

Obstructive sleep apnoea inhibits the recovery of left ventricular function in patients with acute myocardial infarction.

AIMS: It has been suggested that obstructive sleep apnoea syndrome (OSA) may be a direct cause of left ventricular (LV) systolic dysfunction. This study was designed to examine our hypothesis that OSA inhibits the recovery of LV function in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: Our 86 consecutive first-AMI patients underwent primary percutaneous coronary intervention (PCI). All patients underwent polysomnography and OSA was defined as an apnoea-hypoapnoea index (AHI) > or =15 events/h, of which more than 50% were obstructive. Left ventriculograms immediately after PCI and at 21 days were used to evaluate LV ejection fraction (LVEF), LV end-diastolic volume index, and regional wall motion (RWM) within the infarct area. OSA was observed in 37 patients (43%). All three indices of LV function after primary PCI were comparable between the two groups. Increases in LVEF and RWM during admission were significantly lower in OSA patients than those without OSA (delta LVEF: -0.3+/-9.6 vs. 7.4+/-7.2%, P < 0.001; delta RWM: 0.26+/-1.04 SD/chord vs. 1.16+/-1.20 SD/chord, P = 0.002). Multiple regression analysis showed that AHI correlated negatively with delta LVEF and delta RWM. CONCLUSION: The novel finding is that OSA may inhibit the recovery of LV function in patients with AMI.

Thrombosed Stanford type A dissection of the aorta in an elderly patient following a fall.

Physical or mental exertion is an important antecedent to dissection. A fall is one of the causes of hip fracture in the elderly population. We report the case of a 78-year-old woman who was diagnosed to have a thrombosed aortic dissection after a fall. We wish to emphasize with this case report that aortic dissection should be considered in the differential diagnosis of patients who complain of chest discomfort after a tumbling over.