הצגת מקרים מתוך מפגש החוג מה-25/6
הצגת 3 מקרים: דילמות בטיפול אנטיטרומבוטי בחולים העוברים PCI
Rabin Medical Center
Sheba Medical Center Tel-Hashomer
הטיפול בקריש דם כלילימרכז רפואי בני-ציון
תגובות שהתקבלו:
I am adding my comments here to Dr. Rosenschein Uri exceptional lecture. Before Tapas, few studies demonstrated better results with aspiration (mainly ST resolution: “DEAR MI” JACC 2006, “REMEDIA” JACC 2005, Margheri et al J. Interv. Cardiol. 2007), Does it matter what particles go downstream? Thrombi particles or cholesterol will activate the coagulation system and will cause no- reflow. In my opinion we should be more liberal in using aspiration devices (with a forward looking hole like Export and not the Pronto device with a side hole) before and after angioplasty and after stent deployment. For the rare cases with no reflow after aspiration- nitroprusside can help. Hopefully we will have in the future medication like GLP-1 analogs to be tested in the cath Lab. in my opinion, There is no place for a stents covered with net/mesh (regarding the MGuard™ stent – one 60 pts study from eastern Europe is not a proof of concept, only if long term favourite results will b
demonstrated in a randomized trial). Those just bury the problem that will surface later on as a stent thrombosis – and I refer you to Dr. Renu Virmani’s recent lectures. Problems will surface if large thrombus or plaque is buried under a stent – especially DES but I think we can conclude the same for the stents that are covered with a mesh/net. I am personally doing a translational research on pig model – testing the impact of no reflow from the imaging part and pathophysiology/apoptosis mechanisms.
Dr. Azriel Osherov Uzi
הסיקור בחסות חברת מדטרוניק
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