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The following electronic only articles are published in conjunction with this issue of Heart.
Very late thrombosis after implantation of sirolimus eluting stent
E Karvouni, S Korovesis, D G Katritsis
Stent thrombosis after sirolimus eluting stent implantation has been reported to occur at six hours to 375 days after the procedure and usually within the two weeks after discontinuation of antiplatelet medication. A case is reported of very late stent thrombosis after 17 months of sirolimus eluting stent implantation and eight months after clopidogrel discontinuation despite aspirin continuation. This case underlines the possible need for long term antiplatelet medication among patients receiving sirolimus eluting stents.
Managing a complication after direct stenting: removal of a maldeployed stent with rotational atherectomy
M Herzum, R Cosmeleata, B Maisch
A 40 year old patient presented with acute anterior wall infarction. A non-calcified lesion was stented directly without significant expansion of the stent. Rotational atherectomy successfully removed parts of the maldeployed stent and resistant arterial wall substance allowing full dilatation of the lesion.
Molecular technique identifies the pathogen responsible for culture negative infective endocarditis
G Y Shin, R J Manuel, S Ghori, S Brecker, A S Breathnach
A case of culture negative endocarditis complicated by immune complex glomerulonephritis and severe aortic regurgitation necessitated aortic valve replacement. Empirical treatment with penicillin and gentamicin according to UK guidelines was started. The pathogen, Streptococcus sanguis, was later identified by polymerase chain reaction amplification and sequencing of bacterial 16S ribosomal RNA. This molecular technique is likely to be of increasing importance in determining the aetiology of culture negative infective endocarditis, thus providing essential treatment and epidemiological information.