Intracoronary adenosine administration was well tolerated and significantly improved electrocardiographic outcomes with a tendency towards improvement in MACE, HF and CV mortality that could not reach statistical significance.

No abstract

In CAD patients on clopidogrel therapy, CYP2C19*2 polymorphism is associated with significantly increased adverse cardiovascular events. However, due to the low positive predictive value, routine genetic testing cannot be recommended at present.

Addition of cilostazol to conventional dual antiplatelet therapy significantly lowers platelet reactivity and may explain a decrease in thromboembolic events following coronary intervention; however, additional studies evaluating clinical outcomes will be helpful to determine the benefit of triple antiplatelet therapy.

Chronic mesenteric ischemia (CMI) is often times underrecognized cause of postprandial abdominal pain. More than 90% of all cases of CMI are caused by atherosclerotic occlusion or stenosis of mesenteric arteries. 1 The other causes of CMI include Takayasu diseases, fibromuscular dysplasia, thromboangitis obliterans, polyartertritis nodosum, radiation therapy, and median arcuate syndrome. 1 The classic presentation of CMI has gradual onset with clinical features of significant abdominal angina, food phobia (or anorexia), weight loss, and malnourishment. It is more prevalent in women than men. The majorities of CMI patients have traditional atherosclerotic risk factors and associated peripheral vascular diseases (PVD) or coronary artery diseases (CAD). 2 Clinical presentations may suggest gastrointestinal, hepatic, gallbladder, or pancreatic pathologies. Therefore, a high index of suspicion should be kept for CMI in patients with similar presentation and the diagnosis can be confirmed by bolus-timed spiral computed tomography angiography (CTA) of abdomen or mesenteric vessels duplex ultrasonography. Traditionally, the treatment of choice has been either operative revascularization (OR) or endovascular revascularization (ER). 2 Hereby, we present a case of chronic triple mesenteric vessel occlusion treated by isolated angioplasty and stenting of the inferior mesenteric artery (IMA) ostial stenosis and illustrate the angiographic findings before and after the procedure and various treatment alternatives. Keywords► non-ST elevation myocardial infarction ► superior mesenteric artery ► inferior mesenteric artery AbstractWe report a rare clinical scenario of chronic mesenteric ischemia (CMI) patient with obstruction of all the three major gut vessels including celiac, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) with a sole artery supplying the collaterals through marginal artery of left colon (the "wandering artery of Drummond").A 70-year-old man was presented to hospital with acute onset of dyspnea, diaphoresis, severe epigastric pain, nausea, and vomiting that started after lunch. Initially, patient was diagnosed and treated for non-ST elevation myocardial infarction (NSTEMI). Furthermore, work-up, including computed tomographic scan of abdomen followed by angiogram, revealed 100% obstruction of celiac and SMA, whereas inferior IMA had 90% ostial lesion with poststenotic dilatation and collaterals supplying to entire colon. Subsequently, IMA ostial lesion was stented through percutaneous intervention and patient noted significantly improved symptoms and quality of life. To conclude, percutaneous endovascular treatments confer favorable strategy for CMI, and it may either be curative or allow nutritional optimization before definitive surgery.