[Role of intravascular ultrasound [IVUS] in determining the therapeutic strategy for the patients with intermediate coronary lesions]

Coronarography presents some limits in assessing intermediate stenosis. Intravascular ultrasound provides tridimensional measurements of the artery, with more reliable data guiding revascularization decision. To evaluate the impact of intravascular ultrasound measurements on revascularization decision of intermediate and ambiguous coronary lesions. We prospectively analysed 40 patients' coronary arteries from March 2009 to November 2011 by both quantitative coronary angiography [QCA] then intravascular ultrasound, and compared our decision before and after intravascular ultrasound. In the final revascularization decision after intravascular ultrasound, medical treatment rate raised from 22% to 25%, percutaneous coronary intervention dropped from 55% to 50%, and coronary artery bypass graft slightly raised from 23% to 25%. Therapeutic decision changed after intravascular ultrasound in 47% of patients [p=0,01], which reflects an important impact of this technique in management of intermediate coronary lesions. Intravascular ultrasound provided more accurate measurements which permitted a better detection of ischemia and influenced notably our therapeutic strategies

[Non-q-wave myocardial infarction: a 31 cases descriptive study]

The frequency of non-Q wave myocardial infarction is permanently increasing. In this retrospective study, we have tried to establish the clinical features, the prognosis and the therapeutic possibilities in this entity. We have studied the clinical history, the physical examination data, the results of the different explorations and the short and long term general course in 31 patients with a non 0 wave myocardial infarction. The main feature of this acute coronary syndrome is the preservation of the myocardial fonction [normal in 64% of the patients]. Concerning the angiograhic finding, we note a high prevalence of severe coronary damages particulary of the stenosis of the left main coronary artery [13,5%] ; but also an important proportion of normal coronary angiographies [20%]. In addition to the known factors associated with a poor prognosis in coronary artery disease, we insist on the severity of the initial depression of the ST-segment. The prognosis of the non Q wave myocardial ifarction is better at the initial phase than that of the "transmural infarction". However, it becomes similar or worse at the long term general course. The important progress in the prognosis markers and in the anti-thrombotic and interventional therapies may maintain at the long term course the good initial prognosis

[ type III aortic dissection. Diagnosis, outcome, contribution of the endovascular therapies to their management - a case report]

The dissection of the descending aorta is a serious affection regarding to its mortality and its complications. It becomes chronic after the 14 Th day following the first signs of dissection. The authors report the case of a 55 years old patient who has presented a type III dissection diagnosed at the chronic period. The persistance of the pain has indicated the implantation of a stent at the intimal tear. This new endovascular treatement of the aorta diseases is a promising and less invasive alternative to the surgical treatement. It may reduce the morbidity and the mortality of this pathology but it needs an accurate and performant imaging techniques

[Aortic stenosis interest of echocardiography with dobutamine]

The stress echocardiography with dobutomine confirms her increasing value for the patients with severe aortic stenosis and left ventricular dysfonction in a diagnosis concept by selecting the true severes stenoses and revealing stenoses overestimated by the low fow, and especially prognosis by means of the stratification of the operatory risk and the search for a contractile reserve which represent the guarantee of a survival per and postoperaloire satisfactory. As regards asymptomatic aortic stenosis the times of intervention are in reevaluation, the compliance valvulaire represente reliable means which needs confirmation for a prophylactic indication for surgery

[Myocardial infarction revealed by ischaemic stroke]

Ischemic cerebral infarction associated with myocardial infarction is yet a real diagnosis challenge. If during the acute myocardial phase the mechanism is mostly embolic, at long terme, the mechanism is not clearant and other causes should be searched. We report a 50 year old man with ischaemic stroke with strong evidence of myocardial infarction in the late phase with wall-motion abormality and mural clot revealed by echocardiography and Q waves. Atrial fibrillation was suspected and no other abnormalities could be found. The diagnosis of cardio-embolic ischaemic stroke could not be made with certainty