Nasir Rahman

Aga Khan University Hospital, Karachi, Kurrachee, Sindh, Pakistan

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Publications (13)12.13 Total impact

  • Sajid Dhakam, Nasir Rahman
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    ABSTRACT: A middle aged male underwent series of percutaneous coronary intervention (PCI) of left main stenosis for CCS IV angina. He developed recurrent severe proliferative in-stent restenosis which was treated with different available options including drug-eluting stents and finally with drug-eluting balloons. During his treatment, challenges of PCI including left main chronic total occlusion PCI, complications like coronary perforation were encountered and treated successfully. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 12/2013; · 2.51 Impact Factor
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    ABSTRACT: The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan. All patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis. Patient baseline characteristics and angiographic data about the lesion characteristics were obtained. Postprocedural and follow-up endpoints, including cardiac death, myocardial infarction, and repeat revascularization, ie, major adverse cardiovascular events (MACE), were included in the analysis. A total of 26 patients received treatment with DEB in the study period, with a significant number having major predisposing factors for the development of ischemic heart disease (IHD; 46% diabetics; 92% hypertensives). The culprit lesion was most commonly identified in the left anterior descending (31%), with presence of American College of Cardiology/American Heart Association lesion type C in 68% of patients. The SeQuent Please paclitaxel-eluting balloon (B. Braun) was used for revascularization. Patients were followed for a median of 16 months. Only 5 patients (19%) developed MACE during this period. Our experience demonstrates the effectiveness of DEBs in the treatment of drug-eluting ISR, especially in complex lesions with patients having significant risk factors for development of IHD. However, further studies are needed to define their indications in this role.
    The Journal of invasive cardiology 07/2012; 24(7):335-8. · 1.57 Impact Factor
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    Nasir Rahman, Sajid Dhakam
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    ABSTRACT: Primary percutaneous intervention (PCI) in acute ST elevation myocardial infarction (MI) is a preferred way of treatment nowadays. Sometimes it becomes difficult to get good myocardial blood flow during PCI if clot burden is large. In this case of an elderly lady, the use of "Mother and Child Technique" combined with super selective pharmacological intervention is demonstrated to achieve good blood flow when conventional means are not working.
    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 10/2011; 21(10):644-6.
  • Sajid Dhakam, Nasir Rahman
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    ABSTRACT: A 22-year old male presented with acute inferior wall myocardial infarction. Coronary angiogram revealed normal left coronary arteries and a giant coronary aneurysm in right coronary artery (RCA). Primary angioplasty of RCA was performed. Large thrombus burden was retrieved with aspiration device and coronary flow restored. However, despite best efforts some thrombus remained and decision to stent was deferred to a later date. Dimensions of aneurysm on quantitative coronary angiogram were 15 mm in width and 46 mm in length. Two weeks later coronary angiogram revealed normal flow in RCA without any angiographically visible thrombus. PCI was performed with two 3.0 × 28 mm Covered stents, Graft Master (JoStent) deployed across the aneurysm, overlapping each other. This completely sealed the aneurysm and intravascular ultrasound confirmed no leakage through the covered stents. Patient remains asymptomatic 2 months post procedure on triple antiplatelet therapy.
    Catheterization and Cardiovascular Interventions 03/2011; 77(4):528-9. · 2.51 Impact Factor
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    Sajid Dhakam, Nasir Rahman
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    ABSTRACT: The case of a coronary artery perforation in which overinflation of a balloon at an angulated segment of the left anterior descending (LAD) artery after stent deployment resulted in an Ellis type III coronary artery perforation is presented. A bare metal stent (BMS) was used successfully to seal this high-grade perforation. Here, it is demonstrated that it may not be illogical to consider BMS as the first choice before embarking on use of a covered stent if the clinical/haemodynamic condition of the patient allows it and if a covered stent is not available.
    Case Reports 01/2010; 2010.
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    Nasir Rahman, Fahim H Jafary
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    ABSTRACT: Glycoprotein IIb/IIIa inhibitors are established treatment for patients who develop acute coronary syndromes. Thrombocytopenia is known to occur following the administration of various drugs, including heparin and glycoprotein IIb/IIIa inhibitors. In the case of glycoprotein IIb/IIIa inhibitors, the mechanism is thought to be drug-dependent antibodies. In most cases, the thrombocytopenia is mild or moderate in severity. Severe thrombocytopenia (platelet count, <50 x 10(9)/L) is distinctly rare. Herein, we report a case of tirofiban-induced thrombocytopenia in which the overall platelet count dropped precipitously to <1 x 10(9)/L within 12 hours of administration; recovery was relatively prolonged, possibly owing to concomitant renal insufficiency. The severity and the rapidity of onset emphasize the need to routinely check platelet counts early after tirofiban administration, in order to prevent sequelae.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2010; 37(1):109-12. · 0.67 Impact Factor
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    ABSTRACT: To investigate association between the Tei index and cardiac complications of ST elevation of Myocardial Infarction. A total of a 202 adult consecutive patients with first ST elevation MI (STEMI) were studied. Tei index was obtained as: (a _ b)/b, where "a" is the interval between the cessation and onset of mitral flow and "b" is the ejection time of aortic flow measured with the help of pulsed Doppler echocardiography. Subsequent complications, included Death, Congestive Heart Failure (CHF), Cardiogenic shock, Atrial Flutter/ Atrial Fibrillation, Sustained ventricular tachycardia, Advanced Atrio- Ventricular Clock (AV Block), Myocardial Infarction (MI), Readmission (due to any cardiac cause) and Revascuralarization during the 30 days after the onset of Acute STEMI were prospectively evaluated and compared with the initial Tei index at admission. Complications were noted in 60% of the patients with acute STEMI. The Tei index was significantly increased for patients with complications compared with those without them (0.66 +/- 0.13 vs. 0.30 +/- 0.10, P < .0001). When Tei index > 0.40 was used for the criteria, the sensitivity, specificity, and overall accuracy to predict subsequent complications were 86%, 82%, and 83%, respectively. Tei index allows approximate but quick and practical noninvasive prediction of complications in patients with STEMI.
    Journal of the Pakistan Medical Association 02/2009; 59(2):75-8. · 0.41 Impact Factor
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    ABSTRACT: Coronary perforation is an uncommon complication of percutaneous coronary intervention and the subset of patients developing a subepicardial hematoma without hemopericardium is even rarer. Subepicardial (or intramyocardial) hematomas are often associated with catastrophic events. These hematomas are reported mainly in those with prior coronary artery bypass grafting (CABG). To date, only 2 cases have been reported in non-CABG patients. Ours is such a case where the perforation failed to resolve. Despite the absence of pericardial effusion or hemodynamic instability, we anticipated the possibility of a dissecting myocardial hematoma and proceeded with preemptive surgery. Perioperative findings confirmed the presence of a large intramyocardial hematoma, conservative treatment of which may well have led to potentially lethal consequences. We then review the scant literature on the subject.
    The Journal of invasive cardiology 08/2008; 20(7):E224-8. · 1.57 Impact Factor
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    ABSTRACT: Coronary stent fractures are very rare. The predisposing factors for stent fractures are excessive postdilatation, overlapping stents and a hinge site in a tortuous coronary artery. We report a case of very late (after 699 days), displaced, sirolimus-eluting stent fracture deployed at nominal pressures without postdilatation and at a non-hinge portion of the left anterior descending artery.
    The Journal of invasive cardiology 06/2008; 20(6):E195-6. · 1.57 Impact Factor
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    ABSTRACT: To assess the availability, practices and knowledge of radiation safety measures among invasive cardiologists in a tertiary care hospital. A cross sectional survey of invasive cardiologists working in academic institutions was conducted using a questionnaire. A total of 28 cardiologists completed the questionnaire with a mean working experience of 10.5 + 7.6 years. All were of the opinion that radiation safety is extremely important and 93% always used lead aprons. Less than half of them used other radiation protective measures including thyroid collar, lead eyeglasses and lead shields. Only 7% regularly utilized a radiation dose badge to monitor the exposure. This may be related to the availability, as lead aprons are readily available but other devices i.e. lead glasses, lead shield and radiation dose badge is available to less than a third of them. On evaluating knowledge only one fourth knew more than 60% of the answers to questions testing the basic principles of radiation safety. When working experience of cardiologists was correlated with their knowledge and practice of radiation safety surprisingly a paradoxical relationship was noted. Mean number of correct answers in those with experience of > 10 years vs < 10 years was 45% vs 56%, p < 0.03. All of the above findings are probably because less than 50% have received any formal education in this important field. There is a lack of standard radiation safety measures and equipments in cardiac catheterization laboratories. Significant lapses exist in practice and lack of knowledge of radiation safety among invasive cardiologists in this part of the world. With rapid growth in the number of cardiac catheterization laboratories in developing countries significant improvement in knowledge, practice and availability of radiation safety measures is needed.
    Journal of the Pakistan Medical Association 03/2008; 58(3):119-22. · 0.41 Impact Factor
  • Nasir Rahman, Javed Tai, Adil Soofi
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    ABSTRACT: The transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction in the absence of obstructive epicardial coronary disease. Although the syndrome has been reported in Japan since 1990, it is rare in other regions. Rapid recognition of the syndrome can modify the diagnostic and therapeutic attitude i.e. avoiding thrombolysis and performing catheterization in the acute phase.
    Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 10/2007; 17(9):562-3. · 0.30 Impact Factor
  • Rahman N, Dhakam S, Nadeem N
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    ABSTRACT: Significant narrowing of the left main coronary artery puts the patient at high risk, since occlusion of this vessel, if unprotected by collateral flow or a patent bypass graft to either the left anterior descending or circumflex artery, compromises flow to approximately 75% of the left ventricle. Percutaneous coronary intervention of left main coronary artery may be the only life saving procedure. There are limited data on the general use of percutaneous intervention (PCI) in patients with acute myocardial infarction (MI) due to left main disease. Small series have noted in-hospital mortality rates of 30 to 35 percent following PCI with or without stenting. Moreover, cardiogenic shock secondary to acute MI, in patients with left main coronary artery disease, carries a very high mortality. Treatment options are limited especially when emergent coronary artery bypass surgery is not an option. We report a case of emergency angioplasty of left main coronary artery with simultaneous kissing stent technique in cardiogenic shock.
    Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 06/2007; 17(5):272-4. · 0.30 Impact Factor
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    ABSTRACT: To assess the characteristics and short-term outcome of patients, undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES), in routine clinical practice. Observational study. The Aga Khan University Hospital, from 2002 to 2003. Patients and Methods: All the patients who underwent PCI with DES at cath lab, AKUH, during the year 2002 and 2003 were included. Data was collected from database and by reviewing clinical records. Follow-up data for a period of 6-9 months was collected from the clinical records and by a telephone interview where required. A total of 141 patients underwent PCI with DES at AKUH during the year 2002 and 2003. This study was predominantly male dominated (approximately 77%), with a mean age of 55+/-11 years. Thirty-nine percent were diabetics, and 53% were hypertensives. Twelve percent of patients had prior coronary artery bypass graft surgery (CABG) and 17% had prior PCI. Two or more than two lesions were attempted in 55% of patients. Majority (84.4%) of lesions were moderate to high risk category. Six to nine months follow-up was available in 133 (94%) patients. The only death was due to heart failure in the presence of a patent stent. Nearly 8% had clinical angina and 3.8% had myocardial infarction (MI) during follow-up. Target lesion revascularization (TLR) was performed in 4.6%. Major adverse cardiac events (MACE), defined as death, MI, and TLR occurred in 6.8% of patients. This data shows that DES are being used in a broad variety of clinical settings in routine or real life clinical practice. The outcome is excellent and comparable to randomized trials.
    Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 06/2006; 16(5):317-9. · 0.30 Impact Factor