Coronary pseudoaneurysm followi ng drug-eluting stent implantation is rare but potentially life-threatening. We report a case of a 55-year-old man with diabetes and hypertension who presented with rest-induced angina three months after percutaneous coronary intervention. Angiography revealed in-stent restenosis with a pseudoaneurysm in the left anterior descending artery. The pseudoaneurysm was successfully treated using a covered stent under intravascular ultrasound (IVUS) guidance. Angiogram showed complete exclusion of the aneurysm and restoration of TIMI-3 flow. This case highlights the role of IVUS-guided covered stent placement as a safe alternative to surgery in selected patients with coronary pseudoaneurysm.
{"title":"Management of pseudoaneurysm following primary percutaneous coronary intervention","authors":"Saroj Kumar Sahoo, Sindhu Rao Malla, Ramachandra Barik, Sai Karthik Kowtarapu, Prabhat Kumar Singh, Debasis Panda, Saran P. Mohanan, Melvin Baby","doi":"10.1016/j.crmic.2025.100130","DOIUrl":"10.1016/j.crmic.2025.100130","url":null,"abstract":"<div><div>Coronary pseudoaneurysm followi<!--> <!-->ng drug-eluting stent implantation is rare but potentially life-threatening. We report a case of a 55-year-old man with diabetes and hypertension who presented with rest-induced angina three months after percutaneous coronary intervention. Angiography revealed in-stent restenosis with a pseudoaneurysm in the left anterior descending artery. The pseudoaneurysm was successfully treated using a covered stent under intravascular ultrasound (IVUS) guidance. Angiogram showed complete exclusion of the aneurysm and restoration of TIMI-3 flow. This case highlights the role of IVUS-guided covered stent placement as a safe alternative to surgery in selected patients with coronary pseudoaneurysm.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100130"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drug-eluting stents have become the foundation of percutaneous coronary intervention (PCI), and advances in intravascular imaging have enabled more precise evaluation of stent expansion, apposition, and coverage. The EluNIR-PERL Ridaforolimus-eluting cobalt–chromium stent represents a new-generation device that combines ultrathin struts with a dual-cell configuration, and platinum–iridium radiopaque markers at both stent ends. The radiopaque markers produce distinct optical coherence tomography (OCT) signatures. We describe this unique feature of the stent in an adult male who had undergone successful PCI of the proximal right coronary artery with OCT optimisation. The stent markers appeared as bright, elongated, linear signals with backscatter on OCT imaging, corresponding precisely to angiographic landmarks.
{"title":"Footprint of EluNIR-PERL stent as visualized by optical coherence tomography: A case report","authors":"Rajesh Vijayvergiya, Anirudh Mukherjee, Tirumalai N.C. Pranav, Chinmay Ankleshwaria","doi":"10.1016/j.crmic.2025.100129","DOIUrl":"10.1016/j.crmic.2025.100129","url":null,"abstract":"<div><div>Drug-eluting stents have become the foundation of percutaneous coronary intervention (PCI), and advances in intravascular imaging have enabled more precise evaluation of stent expansion, apposition, and coverage. The EluNIR-PERL Ridaforolimus-eluting cobalt–chromium stent represents a new-generation device that combines ultrathin struts with a dual-cell configuration, and platinum–iridium radiopaque markers at both stent ends. The radiopaque markers produce distinct optical coherence tomography (OCT) signatures. We describe this unique feature of the stent in an adult male who had undergone successful PCI of the proximal right coronary artery with OCT optimisation. The stent markers appeared as bright, elongated, linear signals with backscatter on OCT imaging, corresponding precisely to angiographic landmarks.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.crmic.2025.100131
Alba Abril Molina , Jose Felix Coserria Sánchez , Manuel Villa Gil Ortega , José Miguel Címbora Delgado , Carmen Federero Fernández , Isabel Merino González , Agustín Guisado Rasco , Mónica Fernández Quero , Rosa M. Cardenal Piris , José Francisco Díaz Fernández
The case of a 5-year-old child with Marfan Syndrome with a left main coronary complication during elective cardiac surgery is presented (mitral valve repair for severe regurgitation and Yacoub surgery with coronary reimplantation due to dilated aortic root). Extrinsic compression of the left main occurred, leading to hemodynamic deterioration and severe left ventricular dysfunction. Emergent angioplasty balloon was performed, ultimately necessitating the implantation of a stent due to its greater radial force. The procedure was guided by intravascular ultrasound to achieve an optimal result. Numerous questions arose regarding the resolution of this case, and finding the best possible solution was crucial due to the patient's age.
{"title":"Extrinsic compression of the left main coronary artery in a child: Is a drug-eluting stent the best solution?","authors":"Alba Abril Molina , Jose Felix Coserria Sánchez , Manuel Villa Gil Ortega , José Miguel Címbora Delgado , Carmen Federero Fernández , Isabel Merino González , Agustín Guisado Rasco , Mónica Fernández Quero , Rosa M. Cardenal Piris , José Francisco Díaz Fernández","doi":"10.1016/j.crmic.2025.100131","DOIUrl":"10.1016/j.crmic.2025.100131","url":null,"abstract":"<div><div>The case of a 5-year-old child with Marfan Syndrome with a left main coronary complication during elective cardiac surgery is presented (mitral valve repair for severe regurgitation and Yacoub surgery with coronary reimplantation due to dilated aortic root). Extrinsic compression of the left main occurred, leading to hemodynamic deterioration and severe left ventricular dysfunction. Emergent angioplasty balloon was performed, ultimately necessitating the implantation of a stent due to its greater radial force. The procedure was guided by intravascular ultrasound to achieve an optimal result. Numerous questions arose regarding the resolution of this case, and finding the best possible solution was crucial due to the patient's age.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100126
Antônio Agostinho Moura Filho , Adnaldo da Silveira Maia , Bruno Silva Ribeiro , Luciana Rascov , Luiz Henrique Dias Gonçalves de Sousa , José Honório de Almeida Palma da Fonseca
Ortner's syndrome, or cardiovocal syndrome, is an uncommon cause of hoarseness resulting from left recurrent laryngeal nerve palsy due to cardiovascular pathology. We present the case of a 78-year-old male with systemic hypertension, chronic kidney disease, and a history of multiple complex aortic repairs, including Stanford type A dissection repair, thoracoabdominal aortic aneurysm reconstruction, and infrarenal endovascular repair. He developed progressive hoarseness and dysphagia over four months. Videolaryngoscopy revealed left vocal fold paresis, and computed tomography angiography demonstrated a 53-mm aortic arch aneurysm with type IA endoleak adjacent to the recurrent laryngeal nerve. The patient underwent zone 0 thoracic endovascular aortic repair with parallel stenting of the brachiocephalic trunk and left carotid artery, and left subclavian artery occlusion. Hoarseness improved significantly by postoperative day one. This case highlights the importance of considering Ortner's syndrome in patients with unexplained hoarseness and aortic disease, as prompt endovascular intervention can achieve rapid symptomatic relief, even before aneurysm sac regression occurs. To our knowledge, Ortner's syndrome occurring after three extensive aortic repairs, including open thoracoabdominal reconstruction and staged endovascular procedures, has not been previously reported.
{"title":"Hoarseness in a patient with aortic arch aneurysm and multiple interventions: A case report of Ortner's syndrome","authors":"Antônio Agostinho Moura Filho , Adnaldo da Silveira Maia , Bruno Silva Ribeiro , Luciana Rascov , Luiz Henrique Dias Gonçalves de Sousa , José Honório de Almeida Palma da Fonseca","doi":"10.1016/j.crmic.2025.100126","DOIUrl":"10.1016/j.crmic.2025.100126","url":null,"abstract":"<div><div>Ortner's syndrome, or cardiovocal syndrome, is an uncommon cause of hoarseness resulting from left recurrent laryngeal nerve palsy due to cardiovascular pathology. We present the case of a 78-year-old male with systemic hypertension, chronic kidney disease, and a history of multiple complex aortic repairs, including Stanford type A dissection repair, thoracoabdominal aortic aneurysm reconstruction, and infrarenal endovascular repair. He developed progressive hoarseness and dysphagia over four months. Videolaryngoscopy revealed left vocal fold paresis, and computed tomography angiography demonstrated a 53-mm aortic arch aneurysm with type IA endoleak adjacent to the recurrent laryngeal nerve. The patient underwent zone 0 thoracic endovascular aortic repair with parallel stenting of the brachiocephalic trunk and left carotid artery, and left subclavian artery occlusion. Hoarseness improved significantly by postoperative day one. This case highlights the importance of considering Ortner's syndrome in patients with unexplained hoarseness and aortic disease, as prompt endovascular intervention can achieve rapid symptomatic relief, even before aneurysm sac regression occurs. To our knowledge, Ortner's syndrome occurring after three extensive aortic repairs, including open thoracoabdominal reconstruction and staged endovascular procedures, has not been previously reported.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100128
Sahlan Abadi , Heny Martini , Anna Fuji Rahimah , Wella Karolina
Background
Transcatheter closure has become a well-established alternative to surgery for suitable secundum Atrial Septal Defect (ASD). Although complex ASD such as those with multiple fenestrations, large size, deficient rims, or septal malalignment are often managed surgically, recent cohort studies have demonstrated successful percutaneous closure in many of these challenging cases using current devices and techniques. Advantages of percutaneous ASD closure are minimally invasive procedure, shorter hospital stay, reduced procedural risks, cosmetic benefits (no surgical scar on the chest), faster recovery, cost-effective, excellent efficacy, safe for older or high-risk patients, and can be performed with zero or minimal fluoroscopy.
Case illustration
A 24-year-old woman, a 25-year-old woman, a 38-year-old woman, and a 69-year-old man presented with exertional dyspnea accompanied by clinical signs of pulmonary hypertension. Transesophageal echocardiography (TEE) identified a large ostium secundum ASD, measuring 35 mm, 33 mm, 40 mm, and 32 mm in diameter, respectively. Transcatheter ASD closure by device with zero fluoroscopy and TEE guidance during the procedure was chosen to close ASD with its own challenges and successfully closed ASD without complications during and after the procedure.
Conclusion
Technological advancements now allow closure of even large ASD using devices. While this method is standard, complications can occur in complex cases — though none were observed in our patients.
{"title":"Closure of complex and large secundum ASD: Is it possible to close by device and by zero fluoroscopy?","authors":"Sahlan Abadi , Heny Martini , Anna Fuji Rahimah , Wella Karolina","doi":"10.1016/j.crmic.2025.100128","DOIUrl":"10.1016/j.crmic.2025.100128","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter closure has become a well-established alternative to surgery for suitable secundum Atrial Septal Defect (ASD). Although complex ASD such as those with multiple fenestrations, large size, deficient rims, or septal malalignment are often managed surgically, recent cohort studies have demonstrated successful percutaneous closure in many of these challenging cases using current devices and techniques. Advantages of percutaneous ASD closure are minimally invasive procedure, shorter hospital stay, reduced procedural risks, cosmetic benefits (no surgical scar on the chest), faster recovery, cost-effective, excellent efficacy, safe for older or high-risk patients, and can be performed with zero or minimal fluoroscopy.</div></div><div><h3>Case illustration</h3><div>A 24-year-old woman, a 25-year-old woman, a 38-year-old woman, and a 69-year-old man presented with exertional dyspnea accompanied by clinical signs of pulmonary hypertension. Transesophageal echocardiography (TEE) identified a large ostium secundum ASD, measuring 35 mm, 33 mm, 40 mm, and 32 mm in diameter, respectively. Transcatheter ASD closure by device with zero fluoroscopy and TEE guidance during the procedure was chosen to close ASD with its own challenges and successfully closed ASD without complications during and after the procedure.</div></div><div><h3>Conclusion</h3><div>Technological advancements now allow closure of even large ASD using devices. While this method is standard, complications can occur in complex cases — though none were observed in our patients.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heavily calcified coronary lesions pose significant challenges during percutaneous coronary intervention (PCI), with increased risks of stent under-expansion and procedural complications. Computed tomography coronary angiography (CCTA) has emerged as a useful tool for lesion assessment and procedural planning, particularly when validated against intravascular imaging.
Case summary
We present three patients with high coronary calcium scores (>400) undergoing PCI. CCTA provided detailed vessel sizing and lesion morphology, which was confirmed by intravascular optical coherence tomography (OCT). Lesion preparation included non-compliant balloon angioplasty and intravascular lithotripsy, followed by drug-eluting stent implantation. OCT validation confirmed adequate stent expansion and apposition, identified peri-procedural complications, and guided further optimization. All cases achieved satisfactory angiographic and clinical outcomes.
Discussion
The series demonstrates the complementary role of CCTA and OCT in managing complex, heavily calcified coronary disease. CCTA enabled accurate pre-procedural planning, while OCT validation ensured procedural safety and stent optimization.
Conclusion
CCTA-guided PCI, with OCT confirmation, may improve outcomes in patients with severe coronary calcification. Larger studies are needed to establish CCTA as a reliable tool for guiding complex PCI.
{"title":"The role of coronary computed tomography angiography in the interventions of calcified coronary lesions: A case series","authors":"Foziyah Alqahtani , Emiliano Bianchini , Sara Sgreva , Sara Alsubai , Naief Almagal , Ruth Sharif , Hesham Elzomor , Faisal Sharif","doi":"10.1016/j.crmic.2025.100124","DOIUrl":"10.1016/j.crmic.2025.100124","url":null,"abstract":"<div><h3>Background</h3><div>Heavily calcified coronary lesions pose significant challenges during percutaneous coronary intervention (PCI), with increased risks of stent under-expansion and procedural complications. Computed tomography coronary angiography (CCTA) has emerged as a useful tool for lesion assessment and procedural planning, particularly when validated against intravascular imaging.</div></div><div><h3>Case summary</h3><div>We present three patients with high coronary calcium scores (>400) undergoing PCI. CCTA provided detailed vessel sizing and lesion morphology, which was confirmed by intravascular optical coherence tomography (OCT). Lesion preparation included non-compliant balloon angioplasty and intravascular lithotripsy, followed by drug-eluting stent implantation. OCT validation confirmed adequate stent expansion and apposition, identified peri-procedural complications, and guided further optimization. All cases achieved satisfactory angiographic and clinical outcomes.</div></div><div><h3>Discussion</h3><div>The series demonstrates the complementary role of CCTA and OCT in managing complex, heavily calcified coronary disease. CCTA enabled accurate pre-procedural planning, while OCT validation ensured procedural safety and stent optimization.</div></div><div><h3>Conclusion</h3><div>CCTA-guided PCI, with OCT confirmation, may improve outcomes in patients with severe coronary calcification. Larger studies are needed to establish CCTA as a reliable tool for guiding complex PCI.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100127
Syed F. Ahmad , Pedro E.P. Carvalho , Eleni Kladou , Emmanouil S. Brilakis
We report a rare case of extensive Stanford type B iatrogenic aortic dissection during complex percutaneous coronary intervention. This case highlights the importance of early recognition, cautious catheter and guidewire manipulation, and tailored imaging to guide management.
{"title":"Iatrogenic aortic dissection while attempting complex percutaneous coronary intervention","authors":"Syed F. Ahmad , Pedro E.P. Carvalho , Eleni Kladou , Emmanouil S. Brilakis","doi":"10.1016/j.crmic.2025.100127","DOIUrl":"10.1016/j.crmic.2025.100127","url":null,"abstract":"<div><div>We report a rare case of extensive Stanford type B iatrogenic aortic dissection during complex percutaneous coronary intervention. This case highlights the importance of early recognition, cautious catheter and guidewire manipulation, and tailored imaging to guide management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fluoropyrimidines and platinum compounds can induce acute coronary syndrome (ACS) and significantly contribute to morbidity in patients with cancer.
Case presentation
A 32-year-old woman with supraglottic squamous cell carcinoma presented with acute chest pain after the first cycle of chemotherapy with cisplatin and 5-fluorouracil. Electrocardiography revealed ST elevation, and an echocardiogram revealed anteroseptal hypokinesia. Coronary angiography revealed a proximal left anterior descending artery thrombus without obstructive stenosis. Intravascular ultrasound confirmed plaque and thrombus with <50 % luminal narrowing, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The patient received dual antiplatelet therapy, anticoagulation, and intravenous glycoprotein PIIb/IIIa inhibitor for 24 h and was discharged after follow-up angiography showing thrombus resolution. Intravascular imaging guided the decision to avoid stenting in this non–obstructive thrombotic lesion.
Conclusion
This case highlights the multifactorial mechanisms of ACS in cancer and the diagnostic utility of intravascular imaging, with caution against attributing events to chemotherapy alone. Contemporary MINOCA evaluation, including intracoronary imaging and cardiac MRI, is essential for defining the underlying mechanism and guiding management.
{"title":"Myocardial infarction with non-obstructive coronary arteries following cisplatin and 5-fluorouracil therapy","authors":"Saroj Kumar Sahoo, Debasis Panda, Ramachandra Barik, Sindhu Rao Malla, Sai Karthik Kowtarapu, Saran P. Mohanan, Prabhat Kumar Singh, Muhiyyud Deen, Mohan Kumar","doi":"10.1016/j.crmic.2025.100125","DOIUrl":"10.1016/j.crmic.2025.100125","url":null,"abstract":"<div><h3>Background</h3><div>Fluoropyrimidines and platinum compounds can induce acute coronary syndrome (ACS) and significantly contribute to morbidity in patients with cancer.</div></div><div><h3>Case presentation</h3><div>A 32-year-old woman with supraglottic squamous cell carcinoma presented with acute chest pain after the first cycle of chemotherapy with cisplatin and 5-fluorouracil. Electrocardiography revealed ST elevation, and an echocardiogram revealed anteroseptal hypokinesia. Coronary angiography revealed a proximal left anterior descending artery thrombus without obstructive stenosis. Intravascular ultrasound confirmed plaque and thrombus with <50 % luminal narrowing, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The patient received dual antiplatelet therapy, anticoagulation, and intravenous glycoprotein PIIb/IIIa inhibitor for 24 h and was discharged after follow-up angiography showing thrombus resolution. Intravascular imaging guided the decision to avoid stenting in this non–obstructive thrombotic lesion.</div></div><div><h3>Conclusion</h3><div>This case highlights the multifactorial mechanisms of ACS in cancer and the diagnostic utility of intravascular imaging, with caution against attributing events to chemotherapy alone. Contemporary MINOCA evaluation, including intracoronary imaging and cardiac MRI, is essential for defining the underlying mechanism and guiding management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100123
Matthew Hammond-Haley , Arif Khokhar , Adam Hartley , Saud Khawaja , Nearchos Hadjiloizou , Bushra Rana , Nilesh Sutaria , Ben Ariff , Edward Barden , Alessandro Viviano , Ghada Mikhail , Iqbal Malik , Neil Ruparelia
We report the case of an 85-year-old female with severe aortic stenosis, who was transferred to our centre for transcatheter aortic valve replacement (TAVR) after presenting to her local hospital in acute pulmonary oedema. Computed tomography (CT) demonstrated anomalous coronary arteries, with both the right coronary artery (RCA) and left coronary artery (LCA) arising from the right coronary cusp (RCC). The coronary heights were low for both the RCA and LCA and the simulated valve to coronary (VTC) distances narrow, suggesting high risk of coronary obstruction following TAVR. Further complicating factors were an effaced aortic root, and the presence of a previous mechanical mitral valve 6 mm below the level of the aortic annular plane. In this case we discuss the pre-procedural planning considerations and procedural steps, in this case double chimney stenting from the same aortic cusp, to successfully navigate this unusual and high-risk anatomy.
{"title":"TAVR with double chimney stenting from the same coronary cusp in anomalous and high-risk anatomy","authors":"Matthew Hammond-Haley , Arif Khokhar , Adam Hartley , Saud Khawaja , Nearchos Hadjiloizou , Bushra Rana , Nilesh Sutaria , Ben Ariff , Edward Barden , Alessandro Viviano , Ghada Mikhail , Iqbal Malik , Neil Ruparelia","doi":"10.1016/j.crmic.2025.100123","DOIUrl":"10.1016/j.crmic.2025.100123","url":null,"abstract":"<div><div>We report the case of an 85-year-old female with severe aortic stenosis, who was transferred to our centre for transcatheter aortic valve replacement (TAVR) after presenting to her local hospital in acute pulmonary oedema. Computed tomography (CT) demonstrated anomalous coronary arteries, with both the right coronary artery (RCA) and left coronary artery (LCA) arising from the right coronary cusp (RCC). The coronary heights were low for both the RCA and LCA and the simulated valve to coronary (VTC) distances narrow, suggesting high risk of coronary obstruction following TAVR. Further complicating factors were an effaced aortic root, and the presence of a previous mechanical mitral valve 6 mm below the level of the aortic annular plane. In this case we discuss the pre-procedural planning considerations and procedural steps, in this case double chimney stenting from the same aortic cusp, to successfully navigate this unusual and high-risk anatomy.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.crmic.2025.100122
Beni Rai Verma , Shaan Ahmed , Matthew Kogan , Abhishek Chaturvedi , Itsik Ben-Dor , Hayder Hashim , Ron Waksman , Brian Case
Treatment of in-stent restenosis (ISR) is based on the underlying etiology, which is defined by performing intravascular imaging. Usually, ISR is treated with implantation of a second stent layer. In cases of recurrent stenosis of the second implanted stent, management may become complex and require advanced interventional techniques. Here, we present a patient with end-stage liver and kidney disease who developed recurrent dual-layer ISR (mixed etiology: under-expansion and neoatherosclerosis) and required coronary artery revascularization. He underwent successful high-definition intravascular ultrasound guided percutaneous coronary intervention of his recurrent dual-layer ISR using an OPN high-pressure balloon followed by a drug-coated balloon. This treatment strategy addressed the mixed etiology of ISR due to underlying biologic and mechanical factors. It resulted in successful revascularization and allowed the patient to be listed for dual organ transplantation.
{"title":"Two Balloons Can Save Stent(s): Treating Recurrent In-Stent Restenosis","authors":"Beni Rai Verma , Shaan Ahmed , Matthew Kogan , Abhishek Chaturvedi , Itsik Ben-Dor , Hayder Hashim , Ron Waksman , Brian Case","doi":"10.1016/j.crmic.2025.100122","DOIUrl":"10.1016/j.crmic.2025.100122","url":null,"abstract":"<div><div>Treatment of in-stent restenosis (ISR) is based on the underlying etiology, which is defined by performing intravascular imaging. Usually, ISR is treated with implantation of a second stent layer. In cases of recurrent stenosis of the second implanted stent, management may become complex and require advanced interventional techniques. Here, we present a patient with end-stage liver and kidney disease who developed recurrent dual-layer ISR (mixed etiology: under-expansion and neoatherosclerosis) and required coronary artery revascularization. He underwent successful high-definition intravascular ultrasound guided percutaneous coronary intervention of his recurrent dual-layer ISR using an OPN high-pressure balloon followed by a drug-coated balloon. This treatment strategy addressed the mixed etiology of ISR due to underlying biologic and mechanical factors. It resulted in successful revascularization and allowed the patient to be listed for dual organ transplantation.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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