Sudden cardiac arrest associated with major spasm of three coronary arteries was observed about 10 hours after Taxus stent insertion in a three vessel lesion and was successfully treated by intracoronary glyceryl trinitrate infusion. This case illustrates a potential risk associated with drug eluting stent and alerts clinicians to the life threatening risk of spasm when stenting multiple vessels with drug eluting stent (especially the Taxus stent).A 62 year old woman was referred for acute chest pain. ECG and an echocardiogram showed acute inferior myocardial infarction. Coronary angiography showed a total occlusion of the proximal right coronary artery and significant focal stenosis in the mid left anterior descending artery and the proximal left circumflex artery (fig 1). Taxus stents (slow release, polymer based, paclitaxel eluting Express stent, Boston Scientific, Natick, Massachusetts, USA) measuring 3.5 6 28 mm, 3.0 6 24 mm, and 3.5 6 16 mm were successfully implanted in the right coronary artery, left anterior descending artery, and left circumflex artery lesions, respectively, after mandatory predilatation. The patient had been treated with calcium channel antagonist and oral nitrate. Ten hours after the procedure, sudden cardiac arrest developed and advanced cardiac life support was performed. Emergency repeated coronary angiography showed severe diffuse narrowing of three coronary arteries except for the previously implanted stent sites (fig 2). Severe

The RA approach seems to be beneficial for reducing operation time and hospital stay, and for stabilization of the learning curve. Postoperative bleeding should be considered during the period of early experience for the RA approach.

NA Laryngoscope, 126:E347-E355, 2016.

2',6'-Dimethyltyrosine-D-Arg-Phe-Lys-NH2 provides a cardioprotective effect against myocardial ischemia and reperfusion in vivo.

It is feasible and safe to achieve regional myocardial hypothermia by intracoronary infusion of cooled solution in pigs.