Cardiovascular Revascularization Medicine: Interesting Cases最新文献

英文中文

Abandoned guidewire recapture from aortic root using “Guidewire twirling technique” 利用 "导丝旋转技术 "从主动脉根部夺回被遗弃的导丝

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-11-08 DOI: 10.1016/j.crmic.2024.100048

Stefano Sasso , Marcello Marchetta , Andrea Moretti , Vincenzo Bernardo , Gaetano Chiricolo , Giuseppe Massimo Sangiorgi

Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease, but it can be complicated by the loss and fracture of coronary guidewires within the vascular system, leading to severe complications such as vessel damage, occlusion, and embolization. This case report describes a unique and challenging scenario involving an 81-year-old male patient who, during an elective coronary angiography, was found to have a fractured and partially decoiled coronary guidewire extending from the aortic root to the left subclavian artery. The guidewire had likely been left in place during a previous procedure and was not documented in the patient's medical history. Given the potential for life-threatening complications, including occlusion of the left internal mammary artery graft, a percutaneous retrieval was attempted. Initial efforts using a snare system were unsuccessful. However, the guidewire was successfully retrieved using the “twirling guidewires” technique, which involved entangling the fractured wire with three 0.014-inch guidewires and carefully extracting it through a guide catheter. The patient avoided invasive surgery and was discharged without complications the day after. This case highlights the importance of recognizing and managing lost guidewire fragments using various percutaneous techniques, underscoring the need for interventional cardiologists to be adept in both coronary and peripheral retrieval strategies.

经皮冠状动脉介入治疗（PCI）是治疗冠状动脉疾病的常见手术，但它可能因冠状动脉导丝在血管系统内的丢失和断裂而变得复杂，导致血管损伤、闭塞和栓塞等严重并发症。本病例报告描述了一个独特而具有挑战性的情况，一名 81 岁的男性患者在接受择期冠状动脉造影术时，发现一根从主动脉根部延伸至左锁骨下动脉的冠状动脉导丝断裂并部分脱落。这根导丝很可能是在之前的手术中遗留下来的，而且没有记录在患者的病史中。考虑到可能出现危及生命的并发症，包括左乳内动脉移植物闭塞，医生尝试了经皮取出导丝。使用套管系统的初步尝试并不成功。不过，使用 "旋转导丝 "技术成功取回了导丝，即用三根 0.014 英寸的导丝缠住断裂的导丝，然后通过导引导管小心地将其取出。患者避免了侵入性手术，第二天就无并发症地出院了。该病例强调了使用各种经皮技术识别和处理丢失的导丝碎片的重要性，突出了介入心脏病专家需要熟练掌握冠状动脉和外周取线策略。

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引用次数: 0

Inverted left atrial appendage developing after mitral valve replacement surgery 二尖瓣置换手术后出现左房阑尾内翻

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-10-11 DOI: 10.1016/j.crmic.2024.100046

Abdul Rasheed Bahar , Paawanjot Kaur , Manmohan Singh , Shaun Cardozo

An inverted left atrial appendage (ILAA) is a rare occurrence after cardiac surgery and can be misinterpreted as a left atrial thrombus, mass, or vegetation. Transesophageal echocardiography (TEE) used post-operatively is useful in detailed visualization of the left atrium and any abnormality within it. We present a case in which a patient developed an ILAA post mitral valve replacement (MVR) and was diagnosed using TEE. We want to emphasize the importance of TEE post-operatively and that differentials for a left atrial mass must include ILAA, especially after cardiac surgery. This can help in preventing unnecessary anticoagulation and the need for surgical revision.

左房阑尾倒置（ILAA）是心脏手术后的一种罕见情况，可能会被误解为左房血栓、肿块或植被。术后使用的经食道超声心动图（TEE）有助于详细观察左心房及其内部的任何异常。我们介绍了一例患者在二尖瓣置换术（MVR）后出现 ILAA 并通过 TEE 诊断的病例。我们希望强调术后 TEE 的重要性，以及左心房肿块的鉴别必须包括 ILAA，尤其是在心脏手术后。这有助于避免不必要的抗凝治疗和手术翻修的需要。

引用次数: 0

An enigmatic presentation of surgical bioprosthetic aortic valve stenosis 手术生物人工主动脉瓣狭窄的神秘表现

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-10-01 DOI: 10.1016/j.crmic.2024.100047

Akiva Rosenzveig , Shinya Unai , Venu Menon , Grant W. Reed

A 63 year old woman with a history of atrial flutter, hypertension and bicuspid aortic valve status post aortic valve replacement presented with worsening dyspnea and presyncope and echocardiography findings of bioprosthetic valve dysfunction. Imaging found a non-infectious pseudoaneurysm, with subsequent redo sternotomy finding of BioGlue causing increasing gradients.

一名 63 岁的女性在主动脉瓣置换术后出现呼吸困难和阵发性晕厥，超声心动图检查发现其生物人工瓣膜功能障碍，并伴有心房扑动、高血压和主动脉瓣双尖瓣状态。影像学检查发现一个非感染性假性动脉瘤，随后重新进行胸骨切开术发现生物胶导致梯度增加。

引用次数: 0

Conquering acute coronary syndrome in coronary artery ectasia: Thrombus resolution with intracoronary thrombolysis, aspiration thrombectomy, and triple therapy 战胜冠状动脉异位的急性冠状动脉综合征：通过冠状动脉内溶栓、吸入式血栓切除术和三联疗法清除血栓

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-09-18 DOI: 10.1016/j.crmic.2024.100044

Sandeep Kancharla, Matthew Bridges, Christopher Hinson, Alejandro Lemor

We present a case of acute coronary syndrome in a patient with coronary artery ectasia. Intravascular imaging revealed complete thrombotic occlusion of the right coronary artery. Although initial aspiration thrombectomy was ineffective, intracoronary alteplase improved subsequent aspiration attempts. Medical management with anticoagulation alongside antiplatelet therapy reduced thrombotic burden with sustained effect.

我们报告了一例冠状动脉异位患者的急性冠状动脉综合征病例。血管内成像显示右冠状动脉完全血栓闭塞。虽然最初的抽吸血栓切除术效果不佳，但冠状动脉内阿替普酶改善了随后的抽吸尝试。在抗血小板治疗的同时进行抗凝治疗，可持续减轻血栓负担。

引用次数: 0

Saving right radial cardiac catheterization with tortuous subclavian artery using head left turning maneuver for facilitating wire advancement into the ascending aorta 在锁骨下动脉迂曲的情况下，使用头部左转手法将导线推进升主动脉，从而挽救右桡动脉心导管术

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-09-17 DOI: 10.1016/j.crmic.2024.100045

Mohammad Reza Movahed

Cardiac catheterization via the right radial artery is associated with a lower complication rate and is gaining popularity. However, there are unique challenges that can lead to procedural failure. One of the major challenges is advancing guide wire into the ascending aorta in a very tortuous subclavian artery. The deep inspiratory maneuver is one of the important maneuvers to overcome wire advancement into the aorta. However, in some cases, the wire will enter the descending aorta with great difficulty in repositioning in the ascending aorta. In this case, we describe a case of a very tortuous subclavian artery that prevents wire advancement into the ascending aorta despite repositioning the catheter and performing deep inspiratory maneuvers. However, after instructing the patient to move her head to the left, wire advancement into the ascending aorta was easily achieved. In this case report, an easy-to-perform maneuver is described in these tough situations that can save the procedure that was started via the right radial route.

经由右桡动脉进行心导管检查的并发症发生率较低，因此越来越受欢迎。但是，经右侧桡动脉进行心导管手术存在一些独特的挑战，可能导致手术失败。其中一个主要挑战是在非常曲折的锁骨下动脉中将导丝推进升主动脉。深吸气动作是克服导丝推进到主动脉的重要动作之一。然而，在某些情况下，导丝会进入降主动脉，很难在升主动脉中重新定位。在本病例中，我们描述了一个锁骨下动脉非常迂曲的病例，尽管重新定位了导管并进行了深吸气操作，但仍无法将导线推进升主动脉。然而，在指示患者将头向左侧移动后，导线很容易就推进到了升主动脉。本病例报告介绍了在这种困难情况下一种易于操作的方法，它可以挽救经右桡动脉途径开始的手术。

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引用次数: 0

Cardiac tamponade as the first presentation of allograft intolerance of an old transplanted kidney 心肌梗塞是旧肾移植异体不耐受的首发症状

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-09-01 DOI: 10.1016/j.crmic.2024.100040

Grace C. Bloomfield , Bryan J. LeBude , Ramez S.F. Jabaji , Steven R. Potter , Kalyan R. Chitturi , Lowell F. Satler , Ron Waksman , Brian C. Case

We present a case of cardiac tamponade as the presenting sign of intolerance of a failed, non-functioning transplanted kidney. Through this case, we describe a refractory systemic inflammatory response with treatment escalation and ultimate resolution through transplant nephrectomy.

我们介绍了一例心脏填塞病例，该病例是因移植肾功能衰竭而出现的不耐受症状。通过这个病例，我们描述了一种难治性全身炎症反应，经过治疗升级，最终通过移植肾切除术得到了解决。

引用次数: 0

True lumen wiring in spontaneous coronary artery dissection – Keep it true 自发性冠状动脉夹层的真实管腔布线 - 保持真实

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-09-01 DOI: 10.1016/j.crmic.2024.100036

Giuseppe Colletti , Gabriele Gasparini L. , Mihai Cocoi , Alexandre Natalis , Pierpasquale Leone , Claudiu Ungureanu

Spontaneous coronary artery dissection (SCAD) poses a significant challenge in young female patients presenting with acute coronary syndromes. We report a case of a 43-year-old female presenting with non-ST elevation acute coronary syndrome, diagnosed with SCAD. Utilizing a Suoh 0.3 guidewire and microcatheter, successful percutaneous intervention was achieved. Notably, once a position in the true lumen was established, the use of a dual-lumen microcatheter facilitated the identification of the main branch of the true lumen through side-port contrast injection and enabled safe delivery of a second wire within it. This highlights the importance of tailored interventions and innovative tools in managing SCAD effectively.

自发性冠状动脉夹层（SCAD）是年轻女性急性冠状动脉综合征患者面临的一项重大挑战。我们报告了一例 43 岁女性非 ST 段抬高急性冠状动脉综合征患者的病例，她被诊断为 SCAD。通过使用 Suoh 0.3 导丝和微导管，成功实现了经皮介入治疗。值得注意的是，一旦确定了真腔的位置，使用双腔微导管就能通过侧口注射造影剂确定真腔的主要分支，并在其中安全地输送第二根导丝。这凸显了量身定制的干预措施和创新工具在有效管理 SCAD 方面的重要性。

引用次数: 0

Improvement of ischemia by subintimal tracking and re-entry in chronic total occlusion percutaneous coronary intervention 在慢性全闭塞经皮冠状动脉介入治疗中通过内膜下跟踪和再通路改善缺血状况

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-09-01 DOI: 10.1016/j.crmic.2024.100043

Trung Quang Le , Jacob Hayden , Lorenzo Azzalini , Taishi Hirai

A 56-year-old male truck driver with history of percutaneous coronary intervention (PCI) to the left circumflex artery presented for worsening angina. A nuclear stress test showed a moderate reversible defect of the inferior wall. A chronic total occlusion of the mid right coronary artery with patent circumflex stent was documented by coronary angiography. After unsuccessful attempts with anterograde and retrograde wiring and dissection re-entry techniques, the subintimal tracking and re-entry (STAR) technique was utilized to advance the guidewire in an extraplaque fashion into the posterior descending artery and posterolateral branch with kissing balloon angioplasty at the bifurcation. A repeat stress test, as required by the state Department of Transportation, demonstrated a resolution of the previous reversible ischemia defect. The patient's symptoms also improved after STAR. Our case highlights an objective improvement of ischemia after STAR.

一名 56 岁的男性卡车司机因心绞痛恶化前来就诊，他曾接受过左侧环状动脉经皮冠状动脉介入治疗（PCI）。核应力测试显示下壁有中度可逆缺损。冠状动脉造影显示，右冠状动脉中段慢性全闭塞，周动脉支架通畅。在尝试了前行、逆行布线和夹层再入路技术未果后，患者采用了内膜下追踪和再入路（STAR）技术，将导丝以斑块外的方式推进至后降支和后外侧支，并在分叉处进行了吻合球囊血管成形术。根据州交通部的要求，再次进行的压力测试表明，之前的可逆性缺血缺陷已经消除。STAR 术后，患者的症状也得到了改善。我们的病例强调了 STAR 术后缺血的客观改善。

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引用次数: 0

Intracoronary snaring to overcome severe tortuosity in chronic total occlusion percutaneous coronary intervention 慢性全闭塞经皮冠状动脉介入治疗中克服严重迂曲的冠状动脉内卡压术

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-07-27 DOI: 10.1016/j.crmic.2024.100041

Ahmed Al-Ogaili , Salman Allana , Yader Sandoval , Emmanouil S. Brilakis

Severe tortuosity poses a challenge for chronic total occlusion (CTO) operators and decreases the success rate of CTO percutaneous coronary intervention (PCI). Extreme angulations are more common in patients with prior coronary artery bypass surgery (CABG) especially at the distal graft anastomosis. We present three challenging CTO PCI cases performed in patients with prior CABG during which intracoronary snaring was implemented to overcome severe tortuosity and successfully recanalize the occlusions.

严重迂曲给慢性全闭塞（CTO）手术医生带来了挑战，并降低了 CTO 经皮冠状动脉介入治疗（PCI）的成功率。在接受过冠状动脉搭桥手术（CABG）的患者中，特别是在远端移植物吻合处，极度迂曲更为常见。我们介绍了三例具有挑战性的 CTO PCI 病例，这三例病例的患者都曾接受过 CABG 手术，在手术过程中，我们采用了冠状动脉内栓塞技术来克服严重的迂曲，并成功地对闭塞部位进行了再通。

引用次数: 0

An unusual retrieval of semi-detached stent: A multistage procedure 不寻常的半脱落支架取出术：多阶段手术

Cardiovascular Revascularization Medicine: Interesting Cases

Pub Date : 2024-07-25 DOI: 10.1016/j.crmic.2024.100042

Mahmut Ekrem Cunetoglu, Volkan Kozluca, Bilge Nazar Ates, Cagdas Ozdol, Ali Timucin Altin

The occurrence of coronary artery stent detachment from the balloon is infrequent during cardiac procedures, although it poses a potentially grave consequence. It can result in the development of induced coronary thrombosis, myocardial infarction, and disruption of peripheral and cerebral blood circulation. There is no universally accepted procedure for extracting the stent, however, several techniques and their combinations can be employed based on the specific circumstances of the case and the ingenuity of the operator. Various techniques were employed to extract the stripped stent in the right coronary artery (RCA), and ultimately it was effectively retrieved using an untested approach.

在心脏手术过程中，冠状动脉支架从球囊脱落的情况并不常见，但它可能造成严重后果。它可能导致诱发冠状动脉血栓形成、心肌梗死以及外周和大脑血液循环的破坏。目前还没有公认的提取支架的程序，但可以根据具体情况和操作者的聪明才智采用多种技术及其组合。为了取出右冠状动脉（RCA）中剥离的支架，我们采用了多种技术，最终使用一种未经测试的方法有效地取出了支架。

引用次数: 0

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