Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre.

Background: The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined.

Method: We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre.

Optical coherence tomography findings during "evolving" stent thrombosis.

Stent thrombosis is a rare but feared complication. While intravascular ultrasound and optical coherence tomography are frequently used to unravel mechanical predisposing factors in patients suffering from this dreadful complication, no information exists on the early pathophysiology of stent thrombosis before coronary flow has been interrupted. We present a case where optical coherence tomography was used to gain novel insights into the earliest stages of stent thrombosis.

Treatment of a giant coronary artery aneurysm: intravascular ultrasound and optical coherence tomography findings.

A giant coronary aneurysm (GCA) partially thrombosed was demonstrated in a 77-year-old patient evaluated for an inferior myocardial infarction. Primary angioplasty (balloon only) with suboptimal result was initially obtained. After triple antiplatelet and anticoagulation therapy (4 days), a new angiography was performed and a fusiform GCA was clearly delineated.

Is refined OCT guidance of stent implantation needed?

The development of optical coherence tomography (OCT) provides new opportunities for the evaluation of coronary stents. Having a much higher spatial resolution than intravascular ultrasound (IVUS), OCT is currently used for long-term assessment of stent implantation. In the immediate future, however, it is quite likely that OCT will be used synergically with IVUS to optimise stent deployment; the criteria for optimising stent implantation using OCT will be clearly indebted to the evidence gathered with IVUS, with an added value in contexts like ambiguous images presenting after stenting, or in complex percutaneous coronary interventions (PCI) procedures like bifurcation stenting.

Comparison of fluoroscopic coronary angiography and multi-slice coronary angiography in the characterization of anomalous coronary artery.

Anomalous coronary arteries with an inter-arterial course are associated with sudden cardiac death. We reported a study comparing the accuracy of fluoroscopic coronary angiography (FCA) with that of multi-slice computed tomography (MSCT) coronary angiography in determining the proximal course of anomalous coronary arteries. Twelve patients with thirteen anomalous coronary arteries had both FCA and MSCT coronary angiography were included in this study.