Recanalization of Acute Coronary Closure during Cardiopulmonary Resuscitation : Guiding Catheter Induced Embolization during PTCA Procedure

Acute coronary closure occurs 2-10% during the procedure of PTCA, 50-80% of those events are in the catheterization room. The causes of acute coronary closure are mainly due to dissection, thrombosis or spasm. We recently experienced a case of acute left main coronary artery closure due to guiding catheter induced embolization in the 56 year-old female, unstable angina patient complicated by diabetes mellitus and chronic renal failure. The patient received cardiopulmonary resuscitation shortly after acute closure because of cardiac arrest. During the resuscitation, we performed PTCA at the site of acute closure. The blood pressure maintained normaly after successful recanalization. And then we inserted IABP(intraaortic balloon pump) balloon and did PTCA of original stenosis sites. The patient removed IABP 24 hours later and discharged a month later without complication.

Intravascular Ultrasonographic Detection of Atherosclerotic Lesions in Spastic Segments of the Coronary Arteries in Patients with Variant Angina

Coronary artery spasm plays an important role for evoking myocardial ischemia and infarction as well as sudden cardiac death in patients with variant angina. The coronary anatomy in patients with variant angina has been defined both at autopsy and during coronary arteriography. Severe porximal coronary atherosclerosis of at least one major vessel occurs in 3/4 of patients and the remainder have normal coronary arteries. Coronary angiography is a relatively insensitive diagnostic tool especially in the early stages of coronary artery disease. Due to arterial remodelling, angiographic luminogram may show little or no narrowing even though a large part of the total vessel area is occupied by plaque. Intravascular ultrasonography(IVUS) enables accurate determination of vessel dimensions and wall characteristics and is more sensitive in delineating early intimal changes than angiography. We experienced 2 cases that IVUS showed focal or diffuse atherosclerosis in spastic segments of the coronary arteries, even though they appeared angiographically normal.

Efficacy of Interavascular Ultrasound in the Palmaz-Schatz Stent Implantation: Clinical Experience of 3 Coronary Artery Disease Patients

Intravascular ultrasound is a usful too to assess the adequate stent strut expansion after stent implantation and nowadays it can bo also used as a dicision making method about omitting anticoagulant therapy. We used intravascular ultrasound before and after Palmz-schatz stent implantation in 3 patients with coronary artery narrowings and analysed serial post porcedure lumen diameter, cross sectional area. We think it is a useful tool to assess the effect of stent implantation and post stent balloon dilatation.