A patient with repeated catastrophic multi-vessel coronary spasm after zotarolimus-eluting stent implantation

Multiple Life-threatening Coronary Artery Spasms after Percutaneous Coronary Intervention for Acute Coronary Syndrome

A 69-year-old man who had been hospitalized with acute coronary syndrome (ACS), underwent urgent percutaneous coronary intervention. In the subacute phase, he developed sudden chest pain and hemodynamic deterioration, and urgent coronary angiogram showed multiple coronary artery spasms. The discontinuation of beta-blocker treatment and the administration of a calcium antagonist helped prevent angina attacks. In Japanese patients who tend to have coronary artery spasm, the routine administration of beta-blockers for post-ACS patients with a preserved left ventricular systolic function should be considered carefully.

Intracoronary focal nitroglycerin injection through drilled balloon is very effective in the resolution of coronary spasm versus into proximal coronary artery: A prospective randomized comparison study

BACKGROUND

In this study, we aimed to compare the effectiveness and safety of NTG administration via catheter and local NTG infusion through a perforated balloon in order to prevent coronary spasm from developing during percutaneous intervention.

METHOD

The study began with 1:1 randomization into two groups of a total of 1688 patients scheduled for PCT. A total of 91 patients in the proximal group who developed lesions received 500 mcg NTG through a catheter, while 85 patients in the local group with lesions developed during the procedure received 500 mcg local NTG through a perforated balloon. After excluding patients who did not develop lesions during the procedure, and those without any change in the lesion with NTG application, the study was completed with 74 patients in the local group, and 70 patients in the proximal group.

RESULTS

Both groups were similar in terms of basic characteristics. Incidences of procedure-related hypotension (10% vs 52%, P < 0.001) and tachycardia (20% vs 57%, P < 0.001) were significantly lower in the local NTG group. Success in addressing spasm was significantly higher in the local NTG than in the proximal NTG group (91.66 ± 14.09% vs 75.99 ± 16.86%, P < 0.001).

DISCUSSION

Intracoronary injection with a perforated balloon, a simple technique introduced worldwide with our publication, can be used for administration of local NTG. Using this method, NTG can be better delivered with the perforated balloon to the vascular epithelium because of lower output, higher eruption rate, and perpendicularity to the endothelium. In this application, the balloon can better deliver drugs to the desired area via back-and-forth movements using a 0.014 guidewire.

CONCLUSION

The local administration of NTG to a spasming area through a perforated balloon is more effective and safer than the proximal administration of NTG.

Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature

Lung cancer being the most prevalent malignancy in men and the 3(rd) most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.

Coronary vasomotion dysfunction after everolimus-eluting stent implantation

First generation drug-eluting stent can cause a paradoxical "in-segment" coronary vasoconstriction. This phenomenon was seen with sirolimus, paclitaxel, and, more recently, also with zotarolimus-eluting stent. For the first time, we describe a case of coronary-induced vasoconstriction by everolimus-eluting stents (EES).

Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis

Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.