Pub Date : 2026-03-01Epub Date: 2026-01-23DOI: 10.1016/j.crmic.2026.100137
Habibe Sena Yıldırım , Ersin Doğanözü
Ostial stent deployments are commonly prone to misplacement during coronary interventions. In recent years, intentional extraction of deployed stents has been reported more frequently, in parallel with advances in complex coronary procedures. Here, we present a case report of the purposeful extraction of a previously deployed stent from the ostium of the left anterior descending artery.
{"title":"A bailout solution of misplaced stent implantation, a deployed stent extraction to the ostium of left anterior descending artery: A case report","authors":"Habibe Sena Yıldırım , Ersin Doğanözü","doi":"10.1016/j.crmic.2026.100137","DOIUrl":"10.1016/j.crmic.2026.100137","url":null,"abstract":"<div><div>Ostial stent deployments are commonly prone to misplacement during coronary interventions. In recent years, intentional extraction of deployed stents has been reported more frequently, in parallel with advances in complex coronary procedures. Here, we present a case report of the purposeful extraction of a previously deployed stent from the ostium of the left anterior descending artery.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078489","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 : 2026-03-01Epub Date: 2026-01-23DOI: 10.1016/j.crmic.2026.100136
Pal Shah , Jeffrey Taylor , Woodson Petit-Frere , Khalil Ibrahim , Mayank Kansal , Joaquim Spadoni Barboza
We report a case of percutaneous transcatheter retrieval of a large, right atrial mass in a 71-year-old woman with a history of recurrent melanoma. Although asymptomatic, concern for cardiac metastasis prompted intervention, as imaging alone could not reliably exclude malignant disease. The mass was removed en bloc via right internal jugular access using an ŌNŌ retrieval system and En Snare under transesophageal echocardiographic and fluoroscopic guidance. Histopathology ultimately confirmed papillary fibroelastoma. This case highlights the role of catheter-based mass retrieval as a minimally invasive diagnostic strategy for intracardiac masses in patients with cancer histories.
{"title":"Percutaneous retrieval of a right atrial mass for diagnostic evaluation in a patient with prior melanoma","authors":"Pal Shah , Jeffrey Taylor , Woodson Petit-Frere , Khalil Ibrahim , Mayank Kansal , Joaquim Spadoni Barboza","doi":"10.1016/j.crmic.2026.100136","DOIUrl":"10.1016/j.crmic.2026.100136","url":null,"abstract":"<div><div>We report a case of percutaneous transcatheter retrieval of a large, right atrial mass in a 71-year-old woman with a history of recurrent melanoma. Although asymptomatic, concern for cardiac metastasis prompted intervention, as imaging alone could not reliably exclude malignant disease. The mass was removed en bloc via right internal jugular access using an ŌNŌ retrieval system and En Snare under transesophageal echocardiographic and fluoroscopic guidance. Histopathology ultimately confirmed papillary fibroelastoma. This case highlights the role of catheter-based mass retrieval as a minimally invasive diagnostic strategy for intracardiac masses in patients with cancer histories.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078490","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 : 2026-03-01Epub Date: 2026-03-06DOI: 10.1016/j.crmic.2026.100148
Lucas Uchoa de Assis , Mark M.P. van den Dorpel , Ben J.L. Van den Branden , Nicolas M. Van Mieghem
Transcatheter mitral valve replacement (TMVR) is a less invasive alternative for patients with mitral valve disease who are at high surgical risk. TMVR demonstrates favorable outcomes, however left ventricular outflow tract obstruction (LVOTO) remains a notorious, potentially life-threatening complication. Three-dimensional computational models (3DCMs) have been developed to simulate the residual neo-LVOT and assess the risk of LVOTO. However, they do not account for the interaction between the anterior mitral valve leaflet (AMVL) and the transcatheter heart valve. We present the case of an 81-year-old female who had reassuring pre-procedural neo-LVOT assessment but experienced acute LVOTO due to AMVL displacement following TMVR. This case emphasizes the strengths and limitations of current 3DCMs in accurately predicting LVOT obstruction. Furthermore, we discuss techniques to prevent and manage LVOT obstruction after TMVR.
{"title":"Left ventricular outflow tract obstruction due to anterior mitral valve leaflet displacement following transcatheter mitral valve replacement: Considerations for future digital planning","authors":"Lucas Uchoa de Assis , Mark M.P. van den Dorpel , Ben J.L. Van den Branden , Nicolas M. Van Mieghem","doi":"10.1016/j.crmic.2026.100148","DOIUrl":"10.1016/j.crmic.2026.100148","url":null,"abstract":"<div><div>Transcatheter mitral valve replacement (TMVR) is a less invasive alternative for patients with mitral valve disease who are at high surgical risk. TMVR demonstrates favorable outcomes, however left ventricular outflow tract obstruction (LVOTO) remains a notorious, potentially life-threatening complication. Three-dimensional computational models (3DCMs) have been developed to simulate the residual neo-LVOT and assess the risk of LVOTO. However, they do not account for the interaction between the anterior mitral valve leaflet (AMVL) and the transcatheter heart valve. We present the case of an 81-year-old female who had reassuring pre-procedural neo-LVOT assessment but experienced acute LVOTO due to AMVL displacement following TMVR. This case emphasizes the strengths and limitations of current 3DCMs in accurately predicting LVOT obstruction. Furthermore, we discuss techniques to prevent and manage LVOT obstruction after TMVR.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421892","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}
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":"2026-03-01","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}
Failure of stent delivery despite successful guidewire and balloon passage represents a challenging scenario during percutaneous coronary intervention (PCI). Angiography alone may be insufficient to fully delineate intramural mechanisms underlying selective stent non-deliverability.
Case presentation
A 73-year-old man presented with chest pain and elevated cardiac biomarkers. Coronary angiography revealed diffuse disease of the left anterior descending artery (LAD) and significant stenosis of the obtuse marginal (OM) branch. PCI to the OM branch was successfully performed. Although the guidewire and balloons crossed the LAD lesion without difficulty, repeated attempts to advance a drug-eluting stent were unsuccessful. Intravascular ultrasound (IVUS) revealed subintimal wire tracking with a true–false–true lumen configuration and an associated dissection flap, explaining the selective failure of stent delivery. Rewiring attempts during the index procedure were unsuccessful, and the intervention was deferred.
Intervention and outcome
At repeat intervention three days later, true-lumen access was successfully re-established using the parallel wire technique under IVUS guidance. A drug-eluting stent was deployed from the ostium to distal LAD, restoring TIMI III flow without residual dissection.
Conclusion
This case illustrates how intramural wire tracking may cause selective stent non-deliverability despite preserved balloon crossability. IVUS provided mechanistic clarification and guided safe procedural strategy, underscoring the value of intravascular imaging in complex PCI.
{"title":"When the stent will not cross: True–false–true lumen wire tracking identified by intravascular ultrasound during complex LAD percutaneous coronary intervention","authors":"Saroj Kumar Sahoo, Ramachandra Barik, Debasis Acharya, Dibya Sundar Mahanta, Sindhu Rao Malla, Sai Karthik Kowtarapu, Saran P. Mohanan, Debasis Panda, Md Rubel Hossain, Prabhat Kumar Singh","doi":"10.1016/j.crmic.2026.100145","DOIUrl":"10.1016/j.crmic.2026.100145","url":null,"abstract":"<div><h3>Background</h3><div>Failure of stent delivery despite successful guidewire and balloon passage represents a challenging scenario during percutaneous coronary intervention (PCI). Angiography alone may be insufficient to fully delineate intramural mechanisms underlying selective stent non-deliverability.</div></div><div><h3>Case presentation</h3><div>A 73-year-old man presented with chest pain and elevated cardiac biomarkers. Coronary angiography revealed diffuse disease of the left anterior descending artery (LAD) and significant stenosis of the obtuse marginal (OM) branch. PCI to the OM branch was successfully performed. Although the guidewire and balloons crossed the LAD lesion without difficulty, repeated attempts to advance a drug-eluting stent were unsuccessful. Intravascular ultrasound (IVUS) revealed subintimal wire tracking with a true–false–true lumen configuration and an associated dissection flap, explaining the selective failure of stent delivery. Rewiring attempts during the index procedure were unsuccessful, and the intervention was deferred.</div></div><div><h3>Intervention and outcome</h3><div>At repeat intervention three days later, true-lumen access was successfully re-established using the parallel wire technique under IVUS guidance. A drug-eluting stent was deployed from the ostium to distal LAD, restoring TIMI III flow without residual dissection.</div></div><div><h3>Conclusion</h3><div>This case illustrates how intramural wire tracking may cause selective stent non-deliverability despite preserved balloon crossability. IVUS provided mechanistic clarification and guided safe procedural strategy, underscoring the value of intravascular imaging in complex PCI.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421193","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 : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.crmic.2026.100141
Nicholas Pennza , Aaron Shaikh , Bernardo Cortese
Background
Calcified nodules constitute a significant burden to successful percutaneous coronary interventions, and are associated with high recurrences. This article describes a rare case in which a previously identified non-eruptive calcified nodule was later observed to have an eruptive phenotype in the setting of acute coronary syndrome.
Case summary
A 65-year-old female presented with chest pain and subsequently underwent intra-aortic balloon pump and optical coherence tomography -assisted high-risk percutaneous coronary intervention of the left main artery, which demonstrated an unusually developed eruptive calcified nodule at the location of a previously recognized non-eruptive calcified nodule. Despite procedural success, the patient later suffered a non-ST-elevation myocardial infarction, secondary to plaque fragments re-protrusion into the stent lumen requiring subsequent intervention.
Discussion
Calcified nodules typically become stable, non-eruptive lesions, forming from either healing of a prior eruptive calcified nodule or through progressive lipidic or calcific remodeling. However, this case highlights the atypical progression from a non-eruptive to an eruptive phenotype, underscoring the need for increased vigilance and long-term monitoring of these lesions.
{"title":"An evolutive phenotype of calcified nodule - from silence to noise: A case report","authors":"Nicholas Pennza , Aaron Shaikh , Bernardo Cortese","doi":"10.1016/j.crmic.2026.100141","DOIUrl":"10.1016/j.crmic.2026.100141","url":null,"abstract":"<div><h3>Background</h3><div>Calcified nodules constitute a significant burden to successful percutaneous coronary interventions, and are associated with high recurrences. This article describes a rare case in which a previously identified non-eruptive calcified nodule was later observed to have an eruptive phenotype in the setting of acute coronary syndrome.</div></div><div><h3>Case summary</h3><div>A 65-year-old female presented with chest pain and subsequently underwent intra-aortic balloon pump and optical coherence tomography -assisted high-risk percutaneous coronary intervention of the left main artery, which demonstrated an unusually developed eruptive calcified nodule at the location of a previously recognized non-eruptive calcified nodule. Despite procedural success, the patient later suffered a non-ST-elevation myocardial infarction, secondary to plaque fragments re-protrusion into the stent lumen requiring subsequent intervention.</div></div><div><h3>Discussion</h3><div>Calcified nodules typically become stable, non-eruptive lesions, forming from either healing of a prior eruptive calcified nodule or through progressive lipidic or calcific remodeling. However, this case highlights the atypical progression from a non-eruptive to an eruptive phenotype, underscoring the need for increased vigilance and long-term monitoring of these lesions.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421191","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 : 2026-03-01Epub Date: 2026-01-27DOI: 10.1016/j.crmic.2026.100132
Selcuk OZTURK , Rukiye GONEN OZDEMIR , Hüseyin KANDEMIR , Selen ESKI , Pelin MESE COSKUN , Erkan YILDIRIM
Ventricular septal rupture (VSR) is a rare but serious mechanical complication of myocardial infarction (MI), with its incidence substantially reduced in the era of primary percutaneous coronary intervention (PCI). Early recognition is essential, as delayed diagnosis can lead to progressive heart failure and cardiogenic shock. We present a 64-year-old man who experienced progressive dyspnea, palpitations, and leg swelling over two months. On examination, he had orthopnea, bilateral rales, marked pretibial edema, a pansystolic murmur with thrill, and a pericardial friction rub. Laboratory tests revealed elevated troponin-T, C-reactive protein, D-dimer, and B-type natriuretic peptide, while electrocardiography demonstrated inferior wall necrosis. Transthoracic echocardiography showed a left ventricular aneurysm, biatrial and biventricular dilation, and a 1.5 cm ventricular septal defect in the mid and basal inferior septum, with a significant left-to-right shunt (Qp/Qs: 2.6). Coronary angiography confirmed total proximal right coronary artery occlusion. Due to high surgical risk and potential hemodynamic compromise, urgent percutaneous VSR closure was performed using a 24 mm Amplatzer™ P.I. Muscular VSD Occluder under fluoroscopic and transesophageal echocardiography guidance, resulting in minimal residual shunt. The patient recovered well, required no inotropic support, and was discharged on guideline-directed medical therapy. At six-month follow-up, he remained asymptomatic with stable echocardiographic findings (Qp/Qs: 1.2). This case highlights that post-MI VSR, although uncommon, can present subtly with heart failure symptoms, and demonstrates that transcatheter closure may offer a feasible alternative to surgery in selected high-risk patients.
室间隔破裂（Ventricular septal rupture， VSR）是一种罕见但严重的心肌梗死（MI）机械并发症，在经皮冠状动脉介入治疗（PCI）时代，其发生率大大降低。早期识别至关重要，因为延迟诊断可能导致进行性心力衰竭和心源性休克。我们报告一位64岁的男性，他经历了两个多月的进行性呼吸困难，心悸和腿部肿胀。检查时，他有直鼻息、双侧罗音、明显的胫前水肿、震颤性全收缩期杂音和心包摩擦。实验室检查显示肌钙蛋白-t、c反应蛋白、d -二聚体和b型利钠肽升高，而心电图显示下壁坏死。经胸超声心动图显示左室动脉瘤，双房和双室扩张，中下隔和基底下隔1.5 cm室间隔缺损，伴有明显的左向右分流（Qp/Qs: 2.6）。冠状动脉造影证实全右近端冠状动脉闭塞。由于手术风险高，血流动力学可能受损，在透视和经食管超声心动图指导下，使用24 mm Amplatzer™P.I.肌肉型VSD闭塞器进行紧急经皮VSR关闭，导致剩余分流最小。患者恢复良好，不需要肌力支持，出院时接受指导药物治疗。随访6个月，患者无症状，超声心动图表现稳定（Qp/Qs: 1.2）。本病例强调了心肌梗死后VSR虽然不常见，但可以微妙地表现为心力衰竭症状，并表明经导管闭合可能为选定的高危患者提供手术之外的可行选择。
{"title":"Percutaneous repair of a post-myocardial infarction ventricular septal rupture in a patient presenting with heart failure","authors":"Selcuk OZTURK , Rukiye GONEN OZDEMIR , Hüseyin KANDEMIR , Selen ESKI , Pelin MESE COSKUN , Erkan YILDIRIM","doi":"10.1016/j.crmic.2026.100132","DOIUrl":"10.1016/j.crmic.2026.100132","url":null,"abstract":"<div><div>Ventricular septal rupture (VSR) is a rare but serious mechanical complication of myocardial infarction (MI), with its incidence substantially reduced in the era of primary percutaneous coronary intervention (PCI). Early recognition is essential, as delayed diagnosis can lead to progressive heart failure and cardiogenic shock. We present a 64-year-old man who experienced progressive dyspnea, palpitations, and leg swelling over two months. On examination, he had orthopnea, bilateral rales, marked pretibial edema, a pansystolic murmur with thrill, and a pericardial friction rub. Laboratory tests revealed elevated troponin-T, C-reactive protein, D-dimer, and B-type natriuretic peptide, while electrocardiography demonstrated inferior wall necrosis. Transthoracic echocardiography showed a left ventricular aneurysm, biatrial and biventricular dilation, and a 1.5 cm ventricular septal defect in the mid and basal inferior septum, with a significant left-to-right shunt (Qp/Qs: 2.6). Coronary angiography confirmed total proximal right coronary artery occlusion. Due to high surgical risk and potential hemodynamic compromise, urgent percutaneous VSR closure was performed using a 24 mm Amplatzer™ P.I. Muscular VSD Occluder under fluoroscopic and transesophageal echocardiography guidance, resulting in minimal residual shunt. The patient recovered well, required no inotropic support, and was discharged on guideline-directed medical therapy. At six-month follow-up, he remained asymptomatic with stable echocardiographic findings (Qp/Qs: 1.2). This case highlights that post-MI VSR, although uncommon, can present subtly with heart failure symptoms, and demonstrates that transcatheter closure may offer a feasible alternative to surgery in selected high-risk patients.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189081","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 : 2026-03-01Epub Date: 2026-03-06DOI: 10.1016/j.crmic.2026.100150
Pablo Rojas-Romero , Marta González-Quijano , Alba Abril-Molina , Manuel Frutos-López , Manuel Villa Gil Ortega , José F. Díaz-Fernández
We present the case of a 56-year-old man who was transferred to the cardiac catheterization laboratory for an anterior ST-segment elevation acute myocardial infarction (STEMI). Coronary angiography revealed no culprit lesions in the coronary arteries. The patient subsequently evolved to in-hospital cardiorespiratory arrest due to refractory ventricular fibrillation, requiring extracorporeal cardiopulmonary resuscitation (ECMO-CPR). A thrombus located in the left sinus of Valsalva, in relation to the ostium of the left main coronary artery, without associated aneurysm or aortic pathology, was identified as the underlying cause. The patient was started on systemic anticoagulation, achieving a reduction in thrombus size. He subsequently made a complete recovery and was ultimately diagnosed with an antiphospholipid syndrome (APS) presenting as arterial thrombosis at an atypical location.
Thrombosis of the sinus of Valsalva in the absence of structural aortopathy is a rare but potentially life-threatening entity, most commonly presenting as STEMI. A multimodal imaging approach is frequently required to confirm the diagnosis and to differentiate it from other conditions. Hypercoagulable disorders, including APS, represent the most frequent underlying cause. Evidence regarding the optimal treatment strategy is limited; appropriate anticoagulation is critical while the addition of thrombectomy may also be an option.
{"title":"Sudden cardiac arrest due to a non-aneurysmal thrombus of the sinus of Valsalva: An unusual presentation of antiphospholipid syndrome","authors":"Pablo Rojas-Romero , Marta González-Quijano , Alba Abril-Molina , Manuel Frutos-López , Manuel Villa Gil Ortega , José F. Díaz-Fernández","doi":"10.1016/j.crmic.2026.100150","DOIUrl":"10.1016/j.crmic.2026.100150","url":null,"abstract":"<div><div>We present the case of a 56-year-old man who was transferred to the cardiac catheterization laboratory for an anterior ST-segment elevation acute myocardial infarction (STEMI). Coronary angiography revealed no culprit lesions in the coronary arteries. The patient subsequently evolved to in-hospital cardiorespiratory arrest due to refractory ventricular fibrillation, requiring extracorporeal cardiopulmonary resuscitation (ECMO-CPR). A thrombus located in the left sinus of Valsalva, in relation to the ostium of the left main coronary artery, without associated aneurysm or aortic pathology, was identified as the underlying cause. The patient was started on systemic anticoagulation, achieving a reduction in thrombus size. He subsequently made a complete recovery and was ultimately diagnosed with an antiphospholipid syndrome (APS) presenting as arterial thrombosis at an atypical location.</div><div>Thrombosis of the sinus of Valsalva in the absence of structural aortopathy is a rare but potentially life-threatening entity, most commonly presenting as STEMI. A multimodal imaging approach is frequently required to confirm the diagnosis and to differentiate it from other conditions. Hypercoagulable disorders, including APS, represent the most frequent underlying cause. Evidence regarding the optimal treatment strategy is limited; appropriate anticoagulation is critical while the addition of thrombectomy may also be an option.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421149","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 : 2026-03-01Epub Date: 2026-02-10DOI: 10.1016/j.crmic.2026.100140
Chantal Y. Asselin , Tasfia Rahman , Joseph De Gregorio
Background
Entrapment of an interventional guidewire during percutaneous coronary intervention (PCI) is rare. Several different techniques may be utilized for retrieval.
Case presentation
An 81-year-old male with multi-vessel disease underwent PCI for unstable angina when a guidewire became entrapped. Neither balloon or micro catheters, or various wires could cross. Manual pull was ineffective. Intravascular ultrasound imaging did not cross but demonstrated heavily calcified plaque. Shockwave lithotripsy was unsuccessful. Excimer laser coronary atherectomy (ELCA) was performed proximally for lesion modification. Rapturously, the entrapped guidewire was successfully dislodged and safely retrieved.
Conclusion
A progressive approach for entrapped wires should be employed. ELCA may be an effective strategy for entrapped guidewire retrieval.
{"title":"Excimer laser coronary atherectomy for the successful retrieval of an isolated guidewire entrapped in a severely calcified vessel","authors":"Chantal Y. Asselin , Tasfia Rahman , Joseph De Gregorio","doi":"10.1016/j.crmic.2026.100140","DOIUrl":"10.1016/j.crmic.2026.100140","url":null,"abstract":"<div><h3>Background</h3><div>Entrapment of an interventional guidewire during percutaneous coronary intervention (PCI) is rare. Several different techniques may be utilized for retrieval.</div></div><div><h3>Case presentation</h3><div>An 81-year-old male with multi-vessel disease underwent PCI for unstable angina when a guidewire became entrapped. Neither balloon or micro catheters, or various wires could cross. Manual pull was ineffective. Intravascular ultrasound imaging did not cross but demonstrated heavily calcified plaque. Shockwave lithotripsy was unsuccessful. Excimer laser coronary atherectomy (ELCA) was performed proximally for lesion modification. Rapturously, the entrapped guidewire was successfully dislodged and safely retrieved.</div></div><div><h3>Conclusion</h3><div>A progressive approach for entrapped wires should be employed. ELCA may be an effective strategy for entrapped guidewire retrieval.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189079","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 : 2026-03-01Epub Date: 2026-03-06DOI: 10.1016/j.crmic.2026.100152
Danish Yar , Ing Han Lim , Rui Yi Pang , Prabath Joseph Francis , Bernard Wong , Bharat Khialani
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of an epicardial artery follows an intramyocardial course. Although commonly considered benign, MB may precipitate acute coronary syndromes (ACS). We describe a 56-year-old man who presented with anterior ST-elevation myocardial infarction (STEMI) in the absence of obstructive coronary artery disease. Urgent coronary angiography demonstrated marked dynamic systolic compression of the mid-left anterior descending (LAD) artery, consistent with MB, without fixed stenosis. Coronary computed tomography angiography confirmed a tunnelled mid-LAD segment without atherosclerotic plaque, and cardiac magnetic resonance imaging revealed subendocardial late gadolinium enhancement in the LAD territory, confirming infarction. Coronary functional testing was deferred in the acute setting; however, the clinical presentation strongly suggested a vasospastic mechanism in the context of myocardial bridging. The patient was managed conservatively with calcium channel blockers and risk factor modification, remaining asymptomatic at 6-month follow-up. This case underscores the value of multimodality imaging in establishing the anatomical and tissue-level correlates of MB-related ACS and highlights that myocardial bridging, though often incidental, can rarely result in clinically significant ischemia and infarction.
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