Occlusion acute phase

De Oliveira et al. explained the effects of hyaluronidase in terms of a reduction of the water content of the ischemic myocardium [107]. Hyaluronidase would reduce the edema during the acute phase following coronary occlusion and thereby reduce the injury. Intramyocardial edema occurs after the occlusion of coronary arteries, resulting in an increased water content of the myocardial tissues. Hyaluronidase produces a faster diffusion of fluids and thereby reduces edema in the damaged area. To examine the effects of hvaluronidase on in fere-... 

Selective spinal DSA has a better spatial resolution and plays a main role in the exclusion of spinal vascular malformations. In selected cases affection of the radicular artery and occlusion of the anterior spinal artery system can be demonstrated as well as collateral supply even in the later course of the ischemia (Mull et al. 2002). Thus, spinal DSA helps to identify pathologic vascular conditions in spinal cord ischemia. The main indication remains to exclude a spinal vascular malformation. Angiographic information about the acute phase of spinal cord ischemia is not yet available. 

Peripheral arterial occlusion. Heparin may prevent extension of a thrombus and hasten its recanalisation it is commonly used in the acute phase following thrombosis or embolism. There is no case for treating ischaemic peripheral vascular disease with an oral anticoagulant (for prevention, see Antiplatelet drugs). 

The coronary angiography (Figure 1.1) is especially important in the acute phase for diagnosing the disease and correlating the place of occlusion with the ST-segment deviations. It is also useful in the chronic phase of the disease. However, in the chronic phase of Q-wave myocardial infarction (MI) the ECG does not usually predict the... 

Consequently, in order to better assess the prognosis and the extent of the ACSs, and infarcts in the chronic phase, it is very important in the acute phase to establish the correlation between the ST-segment deviations/T changes and the site of occlusion and the area at risk (p. 66), and in the chronic phase between leads with Q wave and number and location of left-ventricular segments infarcted (p. 139) (Figures 1.8 and 1.9). 

In the acute phase of an STE-ACS, the most important thing is to recognise, through ST-segment deviations (elevations and depressions), the site of coronary artery occlusion, correlating with a myocardial area at risk of larger or smaller size, and according to this information, a proper therapeutic decision will be made. 

Occlusion proximal to the SI branch but distal the D1 branch (Figure 4.25 and Table 4.1A(4)) When the occlusion is located above, the SI but not the D1 (Figure 4.25), which rarely occurs (<15% of the STE-ACS), the area at risk could lead to a relatively extensive anterior infarction when the D1 branch is quite small and the D2 branch is large. However, usually more septal and anterior than lateral involvement is seen (Figure 4.25B,C). Currently, with the new treatments employed in the acute phase, most of these cases end up being just an apical infarction... 

We will now remind the ECG differences in acute and chronic phase in case of D1 occlusion and OM occlusion. During the acute phase of infarction due to D1 occlusion (Figure 5.22A), an ST-segment elevation is seen in I and VL and frequently in several precordial leads, sometimes even from V2-V3 to V6, with, generally, an ST-... 

On the other hand, to know where is the site of occlusion (see Table 4.1) in STE-ACS is important, to decide the need and the urgency to perform a primary PCI. As a consequence of reperfusion treatment (fibrinolytic or PCI) it has been shown that the area at risk during the acute phase is larger than the final infarcted area. 

From the prognostic standpoint, Mis of inferolateral zone with RV involvement - proximal occlusion of RCA - especially when the artery is dominant, have worst prognosis in the acute phase, as they potentially involve a very large myocardial area at risk. Consequently, carrying out an urgent coronary angiogram is mandatory (Figures 4.31 and 9.6). 

Figure 10.4 The occlusion of a short RCA produces an Ml of the RV without any repercussion in LV. The ST-segment elevation in V1-V3 in the acute phase can be attributed to an ACS of the LAD, but the slight ST-segment elevation in II, III and VF suggests involvement of a short RCA. The cases of a distal LAD involvement (Figure 4.23) with ST-segment...

Direct Fibrinolytics Alfimeprase is a recombinant tmncated form of fibrolase, a fibrinolytic zinc metalloproteinase isolated from the venom of the Southern copperhead snake. It degrades fibrin directly and achieves thrombolysis independent of plasmin formation. This may result in faster recanalization and a decreased risk of hemorrhagic conversion. The initial data on the safety and efficacy of alfimeprase in peripheral arterial occlusion disease appeared very promising, but recent communication from the sponsor revealed that the phase III trials of the drug in peripheral arterial disease and catheter obstruction (NAPA-2 and SONOMA-2) failed to meet their primary and key secondary endpoints of revascularization. A trial for I AT in acute stroke (CARNEROS-1) is planned to begin soon. 

---