ABSTRACT
Conventional percutaneous transluminal angioplasty (PTA) for complex or long segment infrainguinal occlusive arterial disease is limited by elastic recoil, dissection and restenosis, with high rates of intermediate and long term restenosis . Debulking with excimer laser has been advocated as a useful adjunctive strategy to improve procedural success and long term patency. This paper reviews the technological development of excimer laser, the studies supporting its use in infrainguinal arterial disease, effective and safe lasing techniques, its advantages, limitations and disadvantages. Case examples will be presented to illustrate its use in infrainguinal arterial disease. Although randomized controlled trials are lacking, existing registry and case series studies suggest efficacy of the excimer laser-assisted PTA for complex infrainguinal arterial disease, including patients with critical limb ischemia.
Subject(s)
Angioplasty, Balloon, Laser-Assisted/methods , Arterial Occlusive Diseases/surgery , Leg/blood supply , Peripheral Vascular Diseases/surgery , Angioplasty, Balloon, Laser-Assisted/instrumentation , Humans , Inguinal CanalABSTRACT
The coronary subclavian steal syndrome (CSSS) leading to an acute myocardial infarction (AMI) post-coronary bypass is a rare occurrence. We describe an 83-year-old Indian man who presented with AMI and was subsequently found to have CSSS. The patient had severe stenosis of his left subclavian artery ostium with retrograde flow up his left internal mammary artery graft. Angiographical steal from the left anterior descending artery was demonstrated during coronary angiogram and was thought to be the main contributing cause of his AMI. Percutaneous transfemoral angioplasty and stent implantation was performed to the left subclavian artery, with resolution of myocardial blood flow steal and anterior ischaemia.
Subject(s)
Myocardial Infarction/etiology , Subclavian Steal Syndrome/complications , Aged, 80 and over , Blood Vessel Prosthesis Implantation/methods , Coronary Angiography , Follow-Up Studies , Humans , Male , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/surgery , Stents , Subclavian Steal Syndrome/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The early diagnosis of acute myocardial infarction is crucial for the institution of appropriate reperfusion therapy. We describe a 56-year-old man who developed sudden onset of severe chest tightness. Inferior, posterior and right ventricular ST elevation myocardial infarction was diagnosed on electrocardiography (ECG). The ECG interpretation, differential diagnosis and management are discussed.
