W. Haberbosch — Some interesting cases in the treatment of Acute Coronary Syndrome
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Transcript of W. Haberbosch — Some interesting cases in the treatment of Acute Coronary Syndrome
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W. Haberbosch
Some interesting cases in the treatment of Acute Coronary Syndrome
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Mortality Rate per 100.000 (MI)
Deviation from average
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• Female, 46 years. Heavy pain of all big joints and muscles for 1 week, Lyme disease
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Pathophysiology of Stress Cardiomyopathy
emotional or physical stress
…death of relatives, particularly if unexpected, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses, natural disasters, heavy pain…
Postulated mechanisms include: catecholamine excess, coronary artery spasm, and microvascular dysfunction.
Treatment: Symptomatic
Epidemiology: 2,7% of all Acute Coronyry Syndromes
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Acute Bypass Graft Occlusion
• Male, 78 Years, 9 years after CABG
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• Male, 82 Years, 5 years after CABG
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Bypass-Graft Intervention
• SVG graft intervention accounts approximately for 10% of all PCI in our institution.
• Implantation of coronary stents has become the preferred revascularization strategy for treatment of graft lesions, because redo CABG is associated with an increased morbidity and mortality
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Rahmani M, Cruz RP, Granville DJ, McManus BM. Circ Res. 2006;99:801-815
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thrombus mixed with atheromatous material that contains cholesterol clefts.
Walts AE, Fishbein MC, Sustaita H,Matloff JM. Circulation. 1982;65:197-201
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PCI in Acute Coronary Syndrome due to acute coronary bypass-graft occlusion
Held C, Tornvall P, Stenestrand U. Eur Heart J 2007 28, 316–325
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BMS vs DES in Vein-Graft PCI
Meier P , Brilakis ES, Corti R et al., PLoS One 2010;5:e 11040
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Antithrombotic Therapy
• The preferred parenteral antithrombotic therapy during graft intervention remains to be explored.
• The role of glycoprotein IIb/IIIa antagonists in graft intervention is limited as they failed to demonstrate a reduction in periprocedural MI.
• In some cases thrombolysis may be indicated.
• We treat patients with aspirin and prasugrel for 1 year
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Thrombus Aspiration
• Male, 61, pain since 4 hours
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Bifurcation
• 59 year old male, heavy smoker
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• Female, 78 years, NSTEMI
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Severe aortic-valve stenosis
• 72-year old man with heart failure NYHA III-IV. syncope, systolic, crescendo-decrescendo murmur loudest at the upper right sternal border.
• Echocardiography: Aortic stenosis, gradient 90mmHg
• Catheterization: Gradient 80mmHg
• Treatment: Aortic Valve Replacement
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• aortic valvuloplasty was performed with a 20-mm balloon under pacing rhythm at 220 bpm, resulting in a reduction in aortic valve gradient from 80 mmHg to 35 mmHg.
• Aortography revealed moderate aortic regurgitation and so it was decided not to insert an intra-aortic balloon pump.