W. Haberbosch

Some interesting cases in the treatment of Acute Coronary Syndrome

Mortality Rate per 100.000 (MI)

Deviation from average

• Female, 46 years. Heavy pain of all big joints and muscles for 1 week, Lyme disease

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

Acute Bypass Graft Occlusion

• Male, 78 Years, 9 years after CABG

• Male, 82 Years, 5 years after CABG

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

Rahmani M, Cruz RP, Granville DJ, McManus BM. Circ Res. 2006;99:801-815

thrombus mixed with atheromatous material that contains cholesterol clefts.

Walts AE, Fishbein MC, Sustaita H,Matloff JM. Circulation. 1982;65:197-201

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

BMS vs DES in Vein-Graft PCI

Meier P , Brilakis ES, Corti R et al., PLoS One 2010;5:e 11040

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

Thrombus Aspiration

• Male, 61, pain since 4 hours

Bifurcation

• 59 year old male, heavy smoker

• Female, 78 years, NSTEMI

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

• 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.