W. Haberbosch — Some interesting cases in the treatment of Acute Coronary Syndrome

1. W. Haberbosch
Some interesting cases in
the treatment of Acute
Coronary Syndrome

2. Mortality Rate per 100.000 (MI)
Deviation from
average

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

10. 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

11. Acute Bypass Graft Occlusion
• Male, 78 Years, 9 years after CABG

16. • Male, 82 Years, 5 years after CABG

24. 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

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

26. thrombus mixed with atheromatous material that contains
cholesterol clefts.
Walts AE, Fishbein MC, Sustaita H,Matloff JM. Circulation. 1982;65:197-201

27. 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

28. BMS vs DES in Vein-Graft PCI
Meier P , Brilakis ES, Corti R et al., PLoS One 2010;5:e 11040

29. 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

30. Thrombus Aspiration
• Male, 61, pain since 4 hours

37. Bifurcation
• 59 year old male, heavy smoker

44. • Female, 78 years, NSTEMI

54. 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

62. • 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.