Intracoronary reopro during percutaneous coronary intervention in acute and stable patient can influence stent thrombosis formation [IRPASST] study

In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events [MACE]. Most clinical trials have studied mainly intravenous administration. Intracoronary [IC] bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis [ST]. We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization [TVR]; therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application. This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention [PCI] and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups: Group I [n =199] patient received IC bolus of abciximab [reopro] 0.25 microg/kg during the PCI in cath lab. Group II [n =248] received the standard dose of reopro-a bolus intravenous 0.25 micro g/kg and maintenance dose of 0.125 micro g/kg over 12 h. There were no differences between the groups with regard to diabetes mellitus, group I [56%] vs. group II [58%], P = 0.613; ACS, group I [38%] vs. group II [44%], P = 0.175; Dietthylstilbestrol Drug eluted stent [DES] in group I [66.5%] vs. [57.6%] group II, P = 0.056; Bare Metal Stent [BMS] in group I [33%] vs. [40.7%] group II, P=0.093; target vessel revascularization [TRV] was seen in 9 patients [4%] in group I vs. 16 patients [6%] in group II. ST elevation was seen in 4 patients [2%] in group I vs. 7 patients [2.8%] in group II, all presented with STEMI. In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups [56%], especially in Saudi patients. In-stent restenosis [ISR] was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST

Anomalous origin of the right coronary artery from the proximal left anterior descending artery and a single coronary artery anomaly: three case reports

The anomalous origin of the right coronary artery [RCA] as a branch of the left anterior descending [LAD] artery is a very rare variation of single coronary artery. We have reported three cases in the last 10 years. Among 15,000 coronary angiograms, at least 40 cases have been described previously in the literature. The vast majority of previous reports have described a single anomalous vessel with its origin after the first septal perforator of the LAD. Two of our patients presented with acute coronary syndrome and were found to have three vessel disease and left main. They underwent coronary artery bypass graft surgery [CABG] and third case presented with tachycardia had only mild coronary artery disease [CAD] and was treated medically

Use of microvena snare catheter in non-ST elevation myocardial infarction due to saphenous vein graft occlusive thrombi

Percutaneous coronary intervention of grafts vessel is more challenging due to a higher incidence of periprocedural distal micro-emobilization and myocardial infarction. Percutaneous coronary intervention current guidelines advocate usage of distal embolic protection devices, especially in patients with a large thrombus burden, undergoing percutaneous intervention for vein graft disease. We present a 75-year-old man with acute coronary syndrome who had saphenous vein graft thrombus. This patient was treated successfully by manual aspiration of graft thrombus using a microvena catheter. There is yet no best available therapeutic options for patients undergoing percutaneous coronary intervention of saphenous vein graft lesions