Coronary flow evaluation by densitometric analysis of sequences of coronarographic images.

An indicator dilution method has been designed and applied to measure coronary flow rates in patients undergoing cardiac catheterization. It requires densitometric analysis of two particular angiographic sequences of the artery of interest, acquired digitally under specific conditions imposed on the contrast medium injections. The method was tested first on a simple artery model, and then on coronarography images obtained during routine examinations of patients. A comparative analysis between a group of patients having presumably normal flows and another group exhibiting slow dye progression (SDP) shows a moderate consistency between the method and the clinical assessments.

Coronary artery stent placement as a treatment of acute coronary syndrome in course of variant angina.

High doses of calcium antagonists and nitrates are the treatment of choice in vasospasm angina when no stenosis or mild stenosis is present. In ca. 5-30% patients this kind of treatment is not effective. We present five cases of variant angina with acute coronary syndrome in patients despite standard pharmacological treatment. These patients also did not respond for intracoronary nitroglycerine injection. They were successfully treated with stent implantation in place of vasospasm. Our observations indicate that early enough interventional treatment prevent myocardial infarction. In one case in which stent placement was performed 12 h after clinical manifestation myocardial infarction with Q waves and enzymes release occurred. In others, accurately treated with stent implantation, coronary spasm did not produce myocardial damage. We did not see any clinical and biochemical evidence of myocardial infarction.

[Repeated administration of t-PA and abciximab in a patient with anterior myocardial infarction--a case report]. / Ponowne podanie t-PA z abciximabem w celu utrzymania droznosci tetnicy dozawalowej w zawale sciany przedniej serca.

Repeated administration of t-PA and abciximab in a patient with anterior myocardial infarction - a case report. A case of a 40-year-old male with acute anterior myocardial infarction (MI) is presented. Due to the angiographic equipment failure, the patient did not undergo primary angioplasty and received heparin and 100 mg of t-PA. This treatment was associated with clinical and ECG signs of reperfusion, however, 30 minutes after completion of t-PA infusion, the patient developed clinical and ECG signs of re-occlusion. The decision was made to transfer the patient to a catheterisation laboratory for further invasive treatment, however, it was located 200 km from our centre. Because of that, the patient received another dose of 50 mg of t-PA and abciximab before transportation. Further course was uncomplicated and the patient underwent successful stent implantation in the other centre.

[Angioplasty of unprotected two coronary artery ostia using cardiopulmonary bypass as a single emergency procedure - case report]. / Jednoczasowa angioplastyka niezabezpieczonych ujsc aortalnych obu tetnic wiencowych w krazeniu pozaustrojowym.

Mortality in patients with a significant left main and right coronary artery ostia stenosis is high, reaching 50% during a five-year follow-up period. To date, this type of lesion has been rarely treated with percutaneous coronary interventions (PCI). We present a case of a 50-year-old man who had had coronary artery bypass surgery because of left main stenosis in the past and was currently admitted to the hospital because of unstable angina. Coronary angiography showed tight left main and right coronary ostia stenosis and total occlusion of the left anterior descending artery. Vein grafts were occluded. The PCI procedure combined with the cardiopulmonary bypass was performed. The lesions were dilated and stents were successfully implanted. The patient tolerated the procedure well. He was discharged five days after PCI and the course of a 12-month follow-up was uneventful.

Intervention on the left main coronary artery. Importance of periprocedural and follow-up intravascular ultrasonography guidance.

Periprocedural intravascular ultrasonography guidance for left main coronary artery stenting is well established. However, the role of this tool is also important at follow-up interventions. We present a case of a patient with previous history of left main coronary artery angioplasty. During a recent attempt to treat tight stenosis in the left anterior descending coronary artery, it was not possible to advance the stent into the left main coronary artery. Intravascular ultrasonography explained the difficulties encountered.

[The role of ultrasonography of the peripheral arteries in diagnosing coronary artery disease]. / Czy ocena zmian miazdzycowych w tetnicach obwodowych moze odegrac role w rozpoznawaniu choroby wiencowej?

Atherosclerosis develops simultaneously in multiple arterial beds, that creates opportunity to diagnose of coronary artery disease. Aim of the study was the evaluation of association between atherosclerotic involvement of peripheral arteries assessed by ultrasound and significant coronary artery disease revealed by angiography. Study included 410 patients, (73% males), mean age 56.0 +/- 9.5 year scheduled for coronary angiography. During ultrasound examination of common carotid and common femoral arteries arterial wall intima-media (IMT) thickness and atherosclerotic plaques presence were assessed. Significant coronary artery disease (CAD) was diagnosed with coronary angiography as diameter stenosis > 50%. Intimo-media thickness (IMT) of common carotid arteries did not differ between groups with and without significant coronary artery disease (right 6.6 vs 6.4 mm, p = ns, left 6.9 vs 6.6 mm, p = ns) but in common femoral arterial was greater in patients with coronary artery disease (right 8.2 vs 7.1 mm, p < 0.005, left 7.9 vs 7.1 mm, p = 0.03). Atherosclerotic plaques in carotid and femoral arteries was detected more often in CAD patients (90.1% vs 34.6%, p < 0.0001). Positive predictive value for CAD diagnosis with detection of plaque in carotid or femoral artery was 93% and negative prognostic value for exclusion CAD after plaque exclusion in all arteries was 61%. Search for atherosclerotic plaques in ultrasound examination of peripheral arteries may facilitate CAD diagnosis in selected patients groups.