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The introduction of drug-eluting stents (DES) into clinical practice has led to a significant reduction in the incidence of in-stent restenosis (ISR) compared to implantation of bare metal stents. However, in 2-4% of cases, the development of angiographic restenosis is observed. Vascular Endothelial Growth Factor-A (VEGF-A) promotes early endothelialization of the stented segment, but in some cases can promote progressive neointimal growth due to proinflammatory effects.Aim. To evaluate the influence of plasma VEGF-A level on ISR after DES implantation.Material and methods. We prospectively examined 49 patients who were implanted with DES due to stable coronary artery disease with ischemia-related arterial stenosis >70% according to a stress test, as well as with a fractional flow reserve 0,05). Within 24 hours after stent implantation, a significant increase in VEGF-A level was found in patients who subsequently demonstrated angiographic ISR as follows: from 476 (267; 602) to 1117 (1089; 1573) pg/ml (p

Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Surgical methods such as coronary artery bypass grafting and percutaneous coronary interventions (PCI) are widely used along with traditional conservative therapy in the treatment of coronary artery disease. The disease outcome directly depends on timely diagnosis and treatment. A significant role in predicting the effectiveness of treatment is given to personification of treatment and management of the patient. In this case, the determining component is its individual genetic status. Methods: The study groups included persons of Kazakh nationality which identify themselves, their biological parents, and biological grandparents on the maternal and paternal side as Kazakh. Research groups included 108 people at the age from 45 to 65 years of both sexes. Blood samples genotyping was carried out by PCR using highly specific TaqMan samples. Thermo Fisher cloud application was used for genotypes determining on the base of an automatic algorithm. Results: The article presents the results of the evaluation of gene polymorphisms associated with coronary artery restenosis in a population of Kazakh nationality. 3 SNPs were determined when searching for an association with stenting due to coronary artery thrombosis: rs7543130 (p=0.009324), rs6785930 (p=0.016858), rs7819412 (p=0.061325). Conclusion: Four polymorphisms associated with the risk of developing coronary heart disease were revealed during the study of polymorphisms among the people of the Kazakh population. Three SNPs were determined when searching for an association with stenting due to coronary artery thrombosis. It should be noted that the Bonferonni correction for multiple comparisons did not reveal significant polymorphisms associated with coronary artery disease, which requires further research with more quantity of samples. [ABSTRACT FROM AUTHOR]

Introduction: Contrast induced nephropathy is third most common cause of renal insufficiency following percutaneous coronary angioplasty (PCI)and patients with preexisting renal dysfunction are even at a higher risk for poor outcomes. With the advent of intravascular imaging, safety and efficacy of angioplasty can be improved significantly in these patients., Material and Methods: This observational prospective study included 72 consecutive patients with CKD(eGFR ≤ 45ml/min/m 2 ) and established CAD who underwent absolute zero contrast PCI at a single tertiary center.PCI was planned in patients with significant stenosis and indications for revascularization.All Procedures were performed under dry fluoroscopy and IVUS guidance without use of any contrast.Informed consent,clinical,procedural and follow-up data was collected and analysed., Results: Total 72 patients (90 vessels) with median age of 63 years and eGFR(34.1ml/min/1.73m 2 )underwent zero contrast PCI.Procedure was performed by Femoral(45.6%)and radial (54.4%) route. Total 11 patients (15.3%) underwent left main stenting. Fluoroscopic landmarks such as side-branch wiring(71.1%),floating wire in aorta(22.2%),calcifications(21.1%),bony landmarks such as ribs or vertebrae (45.5%) and Sternal wires/clips(6.6%) were used in addition to IVUS to enable more accurate placement of stent.Technical and procedural success were achieved in 91.1 % and 97.2% of patients.One patient died in hospital due to non-cardiac cause and one patient required hemodialysis.Post procedure at 48 hours ,there was no deterioration of renal function.On 3 months followup, there was no significant major adverse cardiovascular events (MACE)., Conclusion: Our study shows that with the help of fluoroscopy landmarks and intravascular imaging,zero contrast PCI can be performed safely with good clinical outcomes in patients at risk of nephropathy., Competing Interests: Declaration of Competing Interest ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier, a division of RELX India, Pvt. Ltd.)

The number of cancer survivors in the United States is projected to increase by 31% by 2030. With advances in early screening, diagnosis and therapeutic strategies, a steadily increasing number of patients are surviving cancer. Coronary artery disease (CAD) is now one of the leading causes of death amongst cancer survivors, with the latter group of patients having a higher risk of CAD compared to the general population. Our review covers a range of specific challenges faced by doctors when considering percutaneous coronary interventions (PCI) in cancer patients; clinical outcomes in cancer patients undergoing PCI, as well as some important technical considerations to be made when making decisions regarding the management strategy in this special population of patients. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI. Method and materials: We analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up. Results: According to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m2. Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m2). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,

In one multicenter and several single-center studies involving 202 cases, new shapes of transradial access PCI guide catheters were tested following a standardized original protocol. The evaluation included a newly designed score for PCI complexity. Three operators successfully performed the 40 cases of the multicenter study, scoring intermediate to difficult 66% of the cases. New shapes were tested for left and right coronary artery and saphenous vein graft PCIs, with right or left transradial access. The new shapes performed adequately, including in 5F sizing. PCI success and fluoroscopy time were related to the score of complexity. [ABSTRACT FROM AUTHOR]

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In the review the authors analyzed the literature data on the state of knowledge of the problems of genetic polymorphisms CYP2C19 gene response to clopidogrel in patients with acute coronary syndrome. Despite on the technological advances and the widespread use of coronary stenting, restenosis at the site of angioplasty remains the main factor limiting its long-term effectiveness. We made the literature review of the state of the study of the genetic polymorphism of the CYP2C19 gene for a response to clopidogrel in patients with acute coronary syndrome and percutaneous coronary intervention. To achieve this goal, a systematic search and subsequent analysis of publications and online resources were carried out. All publications are indexed in the PubMed, Medline, e-Library, CoogleScholar.

Background: Sudden cardiac arrest is the most common cause of death worldwide, and prognostication after survival remains challenging. Decisions regarding prognosis can be fraught with error in the immediate postarrest period, with guidelines recommending the use of various tests, including blood gas pH, to determine which interventions to perform. Despite these recommendations, the prognostic utility of blood gas pH remains unclear.Objectives: In this retrospective cohort study, we aimed to demonstrate the prognostic utility of emergency department blood gas pH after return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest.Methods: A retrospective cohort study was performed, including all adult survivors of out-of-hospital cardiac arrest (n = 79). Primary disease-oriented outcome was venous blood pH after ROSC and survival to hospital discharge.Results: In patients with out-of-hospital cardiac arrest, pH < 7.2 was associated with decreased likelihood of survival to hospital discharge (odds ratio 0.06), with every 0.1-unit increase in pH being associated with an increased likelihood of survival (1.98). Based on the area under the receiver curve, the pH that optimizes sensitivity and specificity for predicting survival was 7.04.Conclusion: Both presence and degree of acidemia on initial blood gas after ROSC was associated with a decreased likelihood of survival to hospital discharge. The optimal cutoff for prediction in this cohort of patients was 7.04. Using a higher pH cutoff would result in fewer patients receiving intervention that would otherwise have survived. [ABSTRACT FROM AUTHOR]

Introduction: Coronary heart disease is one of the leading causes of death and morbidity in the world. With the advancement of new treatment options, increasing emphasis is being placed on less invasive approach of treating coronary disease, i.e. percutaneous coronary interventions (PCI)¹ . A certain population still benefits most from surgical treatment - coronary artery bypass grafting (CABG)². Cardiac surgery carries a certain risk of peri- and post-procedural bleeding and the need for blood transfusions. Case report: 64-year-old woman patient with long-term arterial hypertension, diabetes, a previous heart attack and PCI of the right coronary artery and ischemic cardiomyopathy with reduced systolic function of the left ventricle, was hospitalized for non-ST-elevation myocardial infarction. Coronary angiography verified three-vessel coronary disease with significant narrowing of the left main coronary artery (LMCA), left anterior descending artery (LAD), chronic occlusion of the circumflex artery, and significant narrowing of the right coronary artery (RCA). Considering the recent guidelines (threevessel coronary disease and diabetes), the patient was referred to a cardiac surgeon and accepted for CABG. As the patient refused to receive blood transfusions for religious reasons, cardiac surgery was abandoned considering the high risk of periprocedural bleeding. The case was presented to the Heart team, considering the wishes of the patient, and it was recommended to do PCI LMCA/LAD and RCA. It is a complex high-risk procedure with a CHIP (Complex High-Risk Indicated PCI) score of 7. As there was no hemodynamic instability and cardiac output were maintained, we did not decide to use mechanical circulatory support in advance. PCI of the ostial RCA with the placement of a drug eluting stent (DES) and then PCI of the LMCA/LAD with the placement of 2 DES was performed. During the intervention, intravascular ultrasound was used to confirm good apposition of the stented segment. The patient was discharged with the recommendation of medications and further monitoring. Conclusion: It is necessary to follow professional recommendations, but always keeping in mind patient’s wishes. Refusal of transfusion treatment presents a difficulty in deciding about the most optimal treatment modality [ABSTRACT FROM AUTHOR]

Rehabilitation is a multidirectional and comprehensive process of action aimed at facilitating the course of recovery, and improving physical and mental fitness. Advances in recent years related to the development of invasive cardiology and cardiosurgery have contributed to the apparent recovery of cardiac patients, because vascular interventions cannot protect patients from progressive disease, i.e. atherosclerosis. In the case of people with cardiovascular disease, we are talking about comprehensive cardiac rehabilitation aimed at stopping the progression of the disease and preventing its tragic effects. Cardiac rehabilitation and secondary prevention are an integral strategy for the management of percutaneous coronary angioplasty based on the reduction of future morbidity and mortality, as well as further improvement in symptoms. The key role here is played by the modification of atherosclerosis risk factors and the introduction of permanent lifestyle changes related to the particular focus on increasing physical activity. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of diabetic status on 2-year clinical outcomes in Chinese patients undergoing contemporary percutaneous coronary intervention (PCI) treatment. Methods and Results: A total of 10 724 consecutive patients underwent PCI at Fu Wai Hospital were prospectively collected. Two-year clinical outcomes were compared between patients with and without diabetes mellitus (DM). Diabetic patients had more baseline clinical risks and more extensive coronary disease. During 2-year follow-up, the rates of all-cause death, myocardial infarction (MI), revascularization, and major adverse cardiac events (MACE) were significantly higher in DM group. After multivariable-adjusted Cox regression analysis, DM was an independent risk factor for MACE but not for the individual components of MACE. After performing propensity score matching, rates of all-cause death, MI, revascularization, stroke, stent thrombosis, and MACE were not significantly different between the 2 groups, and DM was not predictive of MACE and any clinical adverse outcomes. Conclusions: Diabetic patients who underwent PCI had worse prognosis including death and repeat revascularization during 2-year follow-up, but DM was not an independent risk factor for adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Percutaneous coronary angioplasty (PCI) is a technique of invasive treatment of coronary artery disease by expanding and restoring normal circulation in the narrowed coronary artery, caused by the ongoing disease process. The most common reason for coronary artery disease, called stable angina pectoris due to clinical symptoms, is coronary atherosclerosis. The treatment of patients with stable angina pectoris after percutaneous coronary angioplasty is based primarily on the guidelines of the European Society of Cardiology. The key message of the authors is the important role associated with the strategy of cardiovascular disease prevention in order to modify risk factors, and the introduction of permanent lifestyle changes based, among other things, on increased physical activity. The combination of knowledge and skills of caregivers such as doctors, nurses, nutrition experts, and experts in cardiological rehabilitation and conscious participation of the patient in the treatment process is a guarantee of therapeutic success. [ABSTRACT FROM AUTHOR]

Background: Profound reduction in antegrade epicardial coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite the absence of evident vessel dissection, obstruction, or distal vessel embolic cutoff. Study Design: Descriptive study. Setting: Khatum-un-Nabyeen Heart Center for percutaneous coronary intervention. Period: January 2016 and December 2016. Methods and Results: Both males and females with age 30 years or more, presented. Patients with coronary angiograms suggestive of percutaneous coronary intervention were included in the study by using nonprobability, purposive sampling technique. Following ethical and research approval from the hospital administration, clinical profile of the patients was documented. Patients presented with acute coronary syndrome as well as patients with stable coronary artery disease requiring coronary intervention based on clinical, ECG, non-invasive test or coronary angiogram were enrolled in the study. Patients with previous history of PCI or CABG were also included in the study. Pregnant patients were excluded from the study. The objective of this study is to find out the incidence of no reflow phenomenon during PCI in our population. The TIMI flow grade was determined for each treated vessel. The criteria for no-reflow was development of substantial flow reduction (less than TIMI 3 flow) in the absence of apparent dissection, thrombosis, or distal vessel cutoff suggestive of macroembolization. SPSS version 16.0 was used for analyzing the data. Frequency and percentages were used for categorical variables. Mean±SD was used for numerical variables. Data were presented in the form of tables. Conclusions: The no-reflow phenomenon, reduction in distal flow without apparent dissection or distal embolization - occurs in 2.25% of coronary interventions. [ABSTRACT FROM AUTHOR]

Background Although numerous studies, to date, have demonstrated a specific phenomenon called the 'obesity paradox' in patients after percutaneous coronary intervention ( PCI), studies performed in China thus far have consistently shown an absence of this phenomenon. Hypothesis 'Obesity paradox' does exist in Chinese PCI patients. Methods 10 724 consecutive Chinese patients who had undergone PCI treatment at a single center from January 2013 to December 2013 were prospectively recruited. Patients were divided into four groups: underweight (body mass index [ BMI<18.5 kg/m2]), normal weight (18.5 kg/m2≤ BMI<24.0 kg/m2), overweight (24.0 kg/m2≤ BMI<28.0 kg/m2), and obese ( BMI≥28.0 kg/m2). Two-year clinical outcomes were compared across the groups. Results Overall, mean (± SD) BMI of all the patients was 25.9±3.2 kg/m2. The 2-year mortality across underweight, normal weight, overweight, and obese patients in different BMI groups was 2.2%, 1.7%, 1.1%, and 1.0%, respectively ( P=.035). Kaplan-Meier curves revealed that normal weight patients had higher incidence of all-cause mortality than overweight and obese ( P=.015 and P=.020, respectively). Multivariable Cox regression analysis indicated that overweight was an independent predictor of all-cause mortality compared with normal weight ( HR 0.64, 95% CI 0.41-0.98, P=.042). Conclusions Overweight patients have lower risk of mortality after PCI treatment; therefore, the phenomenon of 'obesity paradox' also seems to exist in Chinese PCI patients. [ABSTRACT FROM AUTHOR]

Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction, classically in its apical and mid segments in the absence of coronary lesions, and is often observed after intense stressful events and occasionally associated to an acute medical illness. We describe a case of TCM associated with coronary artery disease and triggered by a percutaneous coronary angioplasty. This case highlights the concept that a medical procedure can lead, in certain conditions, to TCM and provides new interesting insights on the pathophysiology of coronary syndromes. [ABSTRACT FROM AUTHOR]

Drug-eluting stent (DES) failure and conditions thereafter remain issues of concern despite generational advancements in DES technology. Registry data and pathological investigations have shown a variety of causes of late stent thrombosis and very late stent thrombosis. On the other hand, clinical imaging including serial studies can provide information on the conditions during the event, the previous status of the lesion, and the healing process after stent implantation. Therefore we investigated thrombus-related DES failure using coronary angioscopy (CAS), which is a robust tool for thrombus assessment. Five out of 8 thrombotic DES failures were documented during urgent repeat percutaneous coronary intervention (repeat PCI). Four patients underwent CAS before the event, and 5 patients were followed using CAS after repeat PCI for DES failure. Among these cases, there were data before and after the event in 4 patients, which highlighted various patterns of healing after repeat PCI for thrombus-related DES failure, including erosion and yellow plaque underneath the DES. The cause of thrombus formation in this series was delayed healing process, but other possible triggers included restenosis, insufficient DAPT duration, neoatherosclerosis, and vasospasm. In addition to these findings being consistent with previous segmental postmortem studies, invasive imaging modalities can provide data on more than just the event itself, such as sequential comparison and lesion features of the survivor. Accumulation of this knowledge would contribute to generating new hypothesis in the future. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months to reduce the risk of late stent thrombosis, particularly in those with acute coronary syndrome (ACS). Objectives This study hypothesized that antiplatelet treatment with DAPT for 6 months may be noninferior to 24-month DAPT in aspirin-sensitive patients. Methods A multicenter, randomized study assigned patients undergoing implantation of everolimus-eluting stents with confirmed nonresistance to aspirin to receive 6- or 24-month DAPT. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke, and major bleeding at 12 months post-stenting. Results A total of 2,031 patients were enrolled in 70 European and Middle Eastern centers. The trial was prematurely terminated due to recruitment problems, leaving 941 patients randomized to 24-month DAPT and 953 to 6-month DAPT. The 2 treatment groups had similar baseline and procedural characteristics. There was no significant difference in the primary endpoint (24-month: 1.5% vs. 6-month: 1.6%; p = 0.85). Noninferiority was demonstrated for 6- versus 24-month DAPT, with an absolute risk difference of 0.11% (95% confidence interval: −1.04% to 1.26%; p for noninferiority = 0.0002). There were no significant differences in stent thrombosis or bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ (hazard ratio: 1.7 [95% confidence interval: 0.519 to 6.057; p = 0.361]). Conclusions Rates of bleeding and thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. (Is There A LIfe for DES After Discontinuation of Clopidogrel [ITALICplus]; NCT01476020 ) [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the effects of the applied whole-body vibration training (WBV) as additional training to standard rehabilitation programme on exercise tolerance, evaluated through an exercise test, blood lipid profile, and the changes in selected echocardiographic parameters of patients after myocardial infarction. The study involved 63 males. The subjects were divided into two groups: standard—ST (27) and with vibration training—ST + WBV (36). All the subjects had undergone angioplasty with stent implantation. The standard and with vibration training group carried out a 24-day improvement program comprising 22 training units. Each session consisted of endurance, general stamina, and resistance training. Instead of resistance training, the experimental group performed exercises on the vibration platform. Statistically significant changes in both groups were observed in the parameters of the echocardiographic exercise test, such as test duration (p < 0.001), distance covered (p < 0.001), MET (p < 0.001), VO2max (p < 0.001), and HRrest (p < 0.01). The echocardiographic test revealed significant improvement of Left Ventricular Ejection Fraction in both groups (ST + WBV group p = 0.024, ST group p = 0.005). There were no statistically significant changes in blood lipid profile and body mass and composition.

Lenvatinib is a multi-tyrosine kinase inhibitor that inhibits angiogenesis and is currently in use for the treatment of refractory thyroid cancer. Therapy using this agent can be prolonged in patients, although serious complications may ensue among those who require surgical procedures. To the best of our knowledge, the safety of invasive surgical procedures in patients undergoing treatment with lenvatinib has not been fully evaluated. A total of 94 patients were treated with lenvatinib for thyroid cancer between June 2015 and August 2019 at the Kanagawa Cancer Center. Of this cohort, 14 invasive procedures were performed on 11 patients. A total of 8 of these procedures were performed under local anesthesia and 6 under general anesthesia; 3 belonging to the latter group were emergency procedures. No primary wound complications were observed among the patients in the cohort; however, one case of delayed healing secondary to placement of a thoracic drain for acute pneumothorax was reported in the present study. Lenvatinib was initially discontinued in this patient, but it was reintroduced 17 days later due to hypoxemia that may have been related to lung metastases. Hypoxemia improved, although wound healing spanned 14 weeks. Therapy was discontinued prior to percutaneous endoscopic gastrostomy in a patient with local progression; while no wound complications were observed, the patient ultimately died from exacerbation of neoplastic disease. In the current study, which focused on surgical interventions performed on patients undergoing lenvatinib treatment, 1 in 14 wound complications improved conservatively. However, it is critical to recognize that disease progression may occur if drugs are withdrawn prior to performing invasive procedures. [ABSTRACT FROM AUTHOR]

For many years clinicians have been searching for "kidney troponin"- a simple diagnostic tool to assess the risk of acute kidney injury (AKI). Recently, the rise in the variety of contrast-related procedures (contrast computed tomography (CT), percutaneous coronary intervention (PCI) and angiography) has resulted in the increased number of contrast-induced acute kidney injuries (CI-AKI). CIAKI remains an important cause of overall mortality, prolonged hospitalisation and it increases the total costs of therapy. The consequences of kidney dysfunction affect the quality of life and they may lead to disability as well. Despite extensive worldwide research, there are no sensitive and reliable methods of CI-AKI prediction. Kidney Injury Molecule 1 (KIM-1) and Neutrophil Gelatinase Lipocalin (NGAL) have been considered as kidney-specific molecules. High concentrations of these substances before the implementation of contrast-related procedures have been suggested to enable the estimation of kidney vulnerability to CI-AKI and they seem to have the predictive potential for cardiovascular events and overall mortality. According to other authors, routine determination of known inflammation factors (e.g., CRP, WBC, and neutrophil count) may be helpful in the prediction of CIAKI. However, the results of clinical trials provide contrasting results. The pathomechanism of contrast- induced nephropathy remains unclear. Due to its prevalence, the evaluation of the risk of acute kidney injury remains a serious problem to be solved. This paper reviews pathophysiology and suggested optimal markers facilitating the prediction of contrast-induced acute kidney injury., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Pneumonectomy is a procedure that possesses several chronic complications most commonly associated with cardiovascular and respiratory systems. Acute myocardial infarction in patients after pneumonectomy and with other comorbidities represents high risk of interventional complications and mortality. We present a case of effective percutaneous coronary angioplasty in a 75-year-old patient with acute non-STEMI infarction, previous pneumonectomy and multi-organ pathology. Choice of treatment strategy and clinical decision making were further complicated by the presence of multiple risk factors, including impaired respiratory function and advanced age of the patient. However, after the short term stabilization of cardiac and respiratory failure symptoms, the patient underwent successful angioplasty with implantation of a drug eluting stent on the right coronary artery. The patient demonstrated a significant improvement of the symptoms and multiorgan failure parameters after angioplasty. This report shows the effective management strategy of patient with acute myocardial infarction and concomitant multi organ failure with indication for percutaneous coronary intervention., Competing Interests: None., (AJCD Copyright © 2020.)

The common use of stents, including antiproliferative drug-eluting stents, has been a major breakthrough in invasive cardiology. Nowadays, a change in the clinical presentation of patients treated with percutaneous coronary intervention (PCI) is observed. The typical clinical characteristics now include advanced age, diabetes, chronic kidney disease, heart failure, and multilevel atherosclerosis. Age, diabetes, and chronic kidney disease are the main predictors of coronary artery calcifications. Severe coronary artery calcifications are the main factor limiting the efficacy of PCI. Successful stent implantation is challenging in the presence of calcifications, because it is difficult to achieve full stent expansion and proper stent apposition. Therefore, it is necessary to adequately prepare the lesion before stent implantation. This document presents the technique of rotational atherectomy (rotablation) as well as indications for and contraindications to the procedure, along with its possible complications and their prevention. Training in rotablation for operators as well as reimbursement policy for the procedure in Poland are also discussed.