Stenting in acute coronary syndromes

The aim of this study was to assess Early and long-term outcome of intracoronary stent implantation for the treatment of acute coronary syndromes. Stenting has historically been contraindicated in thrombus containing lesion because of the risk of subacute thrombosis. With advance in stent implantation technique, and the recognition of the importance of adequate platelet inhibition, the incidence of subacute thrombosis has progressively fallen despite stenting in increasingly complex subset, inducing acute coronary syndromes and thrombus lader lesions. 50 patients with acute coronary syndromes who underwent coronary stenting where included in the study. According to medical history, resting 12 leads ECG, and serum cardiac enzymes, they were divided into 3 groups; the Q-wave Ml group, the non Q-Wave MI group, and the unstable angina group. All patients were treated with Aspirin, Ticlopidine and Heparin regimen. Through out the study period, 60 stents were successfully implanted in 50 patients [100%] success rate], with TIMI grade 3 restored in the whole study population. During hospitalization and at I month follow-up, there was no death, Q-wave MI or emergency CABG in the 3 groups. There was no major vascular complication but minor bleeding occurred in 16%. Late clinical follow up at a mean follow-up period of 6.3 +/- 1.02 months post coronary stenting showed that there was no death but there was 6% rate of Q-MI, 8% of elective bypass surgery and 8% repeated PCI for stented segments and 6%for non stented segment follow-up angiogram at a mean follow-up time of 6.1 +/- 0.5 stent restenosis rate was 19%. Stent implantation in acute coronary syndromes is associated with excellent early clinical outcome and good long-term results

Impaired carotid artery vasoreactivity in patients developed late coronary in-stent restenosis

Carotid artery response to sympathetic stimulus like cold pressor test [CPT] is altered in the presence of coronary risk factors and coronary artery disease. To investigate whether systemic endothelial function of' the carotid artery is related to angiographic restenosis after coronary stenting. Sixty three men who underwent elective coronary stenting were divided into 2 groups according to the presence or absence of in-stent restenosis 6 months after the procedure. restenosis group [n=12] and non restenosis group [n=20] after exclusion of patients who did not match with restenosis group in regard to age sex and risk factors. another 12 risk factor matched men with normal coronary angiograms served as the control group. Carotid artery vascoreactivity was assessed by CPT and sublingual Ntg. Basal carotid artery diameter [Cad[dram]] did not differ between restenosis non restenosis and control groups [7.23 +/- 0.61 mm. 6.9 +/- 0.65 mm and 7.13 +/- 0.41 mm respectively]. The change in carotid artery diameter [delta CA[dram]] in response to cold pressor test [CPT] was significantly lower in the restenosis group than in the non restenosis group [-0.53 +/- 0.3 mm or -7.1 +/- 2.6% V[s] 0.2 1 +/- 0.13 mm or 3.04 +/- 1.6%] P < 0.05 while delta CA[dram] did not differ in response to nitroglycerin Ntg [0.5 1 +/- 0.16 mm or 7.1 +/- 2.6% V[s] 0.50 +/- 0.21 mm or 7.3 +/- 3.1%]. In contrast delta CA[dram] was significantly lower in patients with angina [-0.45+0.2 mm] than in those without angina [0.24 +/- 0.13 mm] P<0.05. In all patients, the angiographic loss index was correlated negatively to the% delta CA[dram], [r=32, P<0.05.]. Systemic endothelial dysfunction might be one of the contributing factors in the development of' late in-stent restenosis and CA reactivity might he available non- invasive method to assess late in-stent restenosis