Microvascular obstruction (MVO) is one of the most frequent complications encountered dur- ing primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. The embolization of thrombotic material seems to be the leading cause of MVO, and many clinical trials have demonstrated that thrombus aspiration (TA) may be a useful means of preventing this phenomenon. Continuous advancements in technology have contributed to the development of various devices for thrombus aspiration. However, a review of the literature indicates that there is disagreement regarding the role of TA in the prevention and treatment of MVO. TA is increasingly used in the treatment of acute stroke in patients who are admitted to the hospital within eight hours from the onset of symptoms. This review pre- sents the current knowledge regarding the role of TA in the prevention of MVO.

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Introduction: Pulmonary embolism (PE) is the most common cause of vascular death after myocardial infarction and stroke, being associated with high mortality and morbidity rates. The aim of this study was to assess the factors related to 1-year mortality in patients with acute pulmonary embolism who survived the acute event. Material and methods: In total, 104 patients who had survived the acute episode of pulmonary embolism and underwent a one- month follow-up after the acute event were included in the study. The patients were divided into two groups: Group 1 – patients who had survived at one year after being diagnosed with acute PE (80.76%, n = 84), and Group 2 – patients who had died after one year (19.23%, n = 20). Results: There were no differences between the 2 groups in relation to gender (p = 0.3), or cardiovascular risk factors (diabetes: p = 0.5, smoking: p = 0.3, hypertension: p = 1, hyper- cholesterolemia: p = 0.5, hypertriglyceridemia: p = 0.4). Patients who had deceased were sig- nificantly older (73.35 ± 9.37 years vs. 66.36 ± 11.17 years, p = 0.005) and had a higher weight compared to the survivors (85.8 ± 21.09 kg vs. 75.89 ± 22.69 kg, p = 0.03). Left ventricular ejection fraction, measured by cardiac ultrasound, was significantly lower in the deceased group compared to survivors (45.63 ± 8.9% vs. 52.86 ± 6.8%, p = 0.03). Multivariate analysis identified the hemodynamic instability (OR = 3.17, p = 0.007), the presence of left QRS axis deviation (OR = 4.81, p = 0.001), associated pulmonary pathologies (OR = 3.2, p = 0.02) as well as the presence of chronic kidney disease (OR = 5, p = 0.04) as the most powerful predictors of death at 1 year in patients with acute PE surviving the acute event. Conclusions: Factors asso- ciated with a higher mortality rate at 1 year in patients who had survived at 1 month following an acute pulmonary embolism episode included: older age, higher body weight, presence of associated pulmonary pathologies, chronic kidney disease, left axis deviation, low left ven- tricular ejection fraction, hemodynamic instability requiring inotropic support, cardiogenic shock at presentation or cardiac arrest during the acute phase.

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Introduction: The term “myocardial bridging” is used to describe an anatomic variant where a band of cardiac muscle overlies a segment of an epicardial coronary artery. It is a highly debated topic, because it can cause conditions such as acute coronary syndrome. Myocar- dial bridging (MB) can be diagnosed using invasive procedures, but also non-invasive ones, such as Multislice Computed Tomography Angiography (MSCTA). Objectives: A compara- tive analysis was performed on the patients who were admitted to the clinic with typical angina, ischemic ECG changes and muscular bridging shown on MSCTA, and patients with the same symptoms, but without MB. A sub-study was also undertaken in which the MB site and ischemia revealed by thickening of the myocardial muscle, using 3D Polar Mapping, were compared. Materials and methods: A retrospective study assessed 59 patients with typical angina pectoris, shortness of breath and clinical appearance of an acute coronary syndrome, and for whom MSCTA was carried out. Patients were divided into two groups: Group 1 — pa- tients with MB, and Group 2 — patients without MB. Thirty patients in Group 1 had 3D polar mapping to evaluate the thickness of the myocardial muscle. Results: The mean age of our patients with muscular bridging was 55.51 ± 11.4 years, CI 51.57–59.45 years. Patients with- out MB had a mean age of 59.17 ± 9.6 years, CI 54.98–63.6 years, p = 0.211. 24.32% of the patients with MB were females and 60.86% from the patients without MB were males, p = 0.040. 40.54% of patients presented with MB in the first segment of the LAD and 15.62% had an MB in the second segment of LAD. In patients with an ischemic site smaller than 2 cm of the MB, the ischemic myocardial area was more pronounced compared to the patients with higher length MB (21.85 ± 6.123% vs. 17.62 ± 5.856%). Conclusions: MSCTA is an important procedure that contributes to the clinical investigations of patients with typical angina and suspected acute coronary syndrome. There is a good positive correlation between the location of the MB and the ischemic segments as shown on 3D CT-based polar maps.

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Non-ST elevation myocardial infarction (NSTEMI) has the highest long-term mortality rates of all acute coronary syndromes. Usually, NSTEMI occurs in elderly patients (>75 years of age) with multiple associated diseases. The complication rate for NSTEMI, including heart failure or hemorrhages, is significantly higher than that in ST-elevation myocardial infarction patients. The case reported is of a 70 year-old male, with a history of ventriculoperitoneal shunt for obstructive hydrocephalus following a traumatic brain injury, who presented with NSTEMI.