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Call for CASES

Call for CASES. Percutenous Controlled Reperfusion For STEMI. P iotr P. Buszman. Silesian Medical School, Katowice, Poland. Introduction. Distal emblization and reperfusion injury are a major limitations of primary percutaneous intervention in patients with STEMI. Reperfusion injury.

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Call for CASES

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  1. Call for CASES Percutenous Controlled Reperfusion For STEMI PiotrP. Buszman Silesian Medical School, Katowice, Poland

  2. Introduction • Distal emblization and reperfusion injury are a major limitations of primary percutaneous intervention in patients with STEMI.

  3. Reperfusion injury

  4. Description of the problem • Age 60/ male • Symptoms: Acute Myocardial Infarction (chest pain lasting 3 hours) • Medical history: Coronary Hart Desease for 4 years • Risk factors: ex–smoker, hypertension, hypercholesterolemia Total cholesterol 229 mg% HDL 36 mg% LDL 171 mg% TG 109 mg% • Acute anterior myocardial infarct caused by occlusion of the mid LAD. LAD: 45LAO/25 cran

  5. Intended strategy • Primary PTCA with a controlled reperfusion:-local delivery of IIb/IIIa receptor inhibitor intramurally at the site of occlusion and into coronary lumen behind occluded segment-glucose infusion through central lumen of balloon catheter to enhance energetic status of ischaemic myocardium. • Coronary stenting to seal ruptured plaques.

  6. Local drug delivery (LDD) • Administration of GP IIb/IIIa inhibitor – ReoPro: locally directly to the mural thrombus and throug central lumen distaly from occlusion. • Glucose infusion before opening the vessel through the central lumen of the Remedy catheter: 20cc of 10% Glucose. • No arrhythmia during and after reperfusion, no hemodynamic disturbances, Transport microporous catheter Remedy 3,0mm

  7. Reperfusion after LDD • After local drug delivery TIMI 3 flow, a long lesion presented in med. LAD • Stentimplantation 2,75x12mm to medial LAD and 2,5x24mm to distal LAD (Liberty stents.) Timi 3 flow after stentimplantation. No residual stenosis. Patient had no angina after the procedure. ST segment normalization

  8. Ejection Fraction LV prior to PCI: EF=55% LV immediately after PCI: EF=59% Immediate LV function improvement instead of myocardial stunning.

  9. 3 months Follow - up Angiography: No restenesosis in LAD Succesful PCI to dist. Cx LV-EF=65% Further improvement of LV function

  10. Summary • A 60 year old male with acute myocardial infarction was addmitted to the hospital. • ECG showed acute infarction of the anterior wall. • Emergency PCI was performed with use of controlled reperfusion: intracoronary glucose infusion and GP IIb /IIIa inhibitor given intramurally and distaly. Immediate LV function improvement and TIMI 3 was obtained. • 3 months follow-up showed good vessel patency and improved LV ejection fraction.

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