ABSTRACT
We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.
ABSTRACT
OBJECTIVE: Brachial-ankle pulse wave velocity (baPWV) is an indicator of atherosclerotic cardiovascular risks. To identify patients with coronary atherosclerosis before the onset of angina pectoris or myocardial infarction will be desirable. METHODS: We measured the ankle-brachial index and baPWV in 150 consecutive patients with coronary artery disease (CAD). Virtual histology intravascular ultrasound (VH-IVUS) imaging was available in target lesions of 130 patients with symptomatic CAD before percutaneous intervention. Patients were divided into two groups: baPWV of greater than or equal to 1600 cm/s (74 patients) and baPWV of less than 1600 cm/s (56 patients). RESULTS: Patient age was 66±8.33 years in baPWV of greater than or equal to 1600 cm/s group versus 56±10.27 years in baPWV of less than 1600 cm/s group (P<0.0001). Although plaque burden and remodeling index were similar, minimal lumen area was smaller in baPWV of greater than or equal to 1600 cm/s group (P=0.039); and lesion length was longer in the baPWV of greater than or equal to 1600 cm/s group (P=0.033). VH-IVUS analysis of coronary artery plaque composition showed that percent mean and percent maximum dense calcium were higher in the baPWV of greater than or equal to 1600 cm/s group (P=0.0037), and percent maximal calcium correlated with baPWV (r=0.278, P=0.001). CONCLUSION: We concluded that there is a significant relationship between baPWV and the VH-IVUS assessment of CAD. A high baPWV indicates more severe CAD (smaller minimal lumen area and longer lesion length) and greater atherosclerosis disease complexity (more calcified coronary plaque).
