Cardiovascular Revascularization Medicine: Interesting Cases最新文献

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.

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.

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.

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.

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.

Late onset coronary occlusion post-transcatheter aortic valve replacement (TAVR) is a rare yet significant complication. We present an 85-year-old female with chest pain secondary to left main coronary artery obstruction eleven months post-TAVR. Angiography revealed a partial occlusion necessitating percutaneous coronary intervention. Despite initial challenges in engagement due to interaction with the TAVR valve, use of a dual lumen microcatheter facilitated successful stenting, resulting in resolution of the obstruction. This case underscores the diagnostic and therapeutic complexities of late coronary occlusion after TAVR, emphasizing the importance of vigilant recognition and innovative interventional strategies in optimizing patient outcomes.

Spontaneous coronary vasospasm (SCV) can present as coronary stenosis on angiography. Undiagnosed thyrotoxicosis is a rare cause of SCV and patients with unclear history and workup presenting with unstable angina should have thyroid function tested.

Percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass grafting (CABG) could present significant challenges, especially when the navigation of arterial conduits is necessary. The selective cannulation of internal mammary artery (IMA) is the first step of these high-risk procedures, in which technical complexities and ischemic complications are frequently faced. Acknowledging the lack of pre-shaped guiding catheter alternatives, IMA cannulation is time and contrast–consuming and potentially dangerous, as both catheter probing and wiring attempts may threaten vessel integrity.

To address this unmet need we developed a novel, easy-to-use technique to achieve selective internal mammary artery (IMA) graft cannulation. Our method proposes to first engage the arterial graft by means of any diagnostic catheter, whose shape can be chosen according to the specific features of the graft. Afterwards, a 0.014-inch workhorse guidewire is advanced to the distal segment of the graft. A 5- or 6-French IM guiding catheter is finally tracked over the wire rail into the ostium to reach stable engagement, ensuring procedural success. This approach is applicable irrespective of access route (ipsilateral or contralateral, transradial or transfemoral), and ultimately reduces procedural complexities and ischemic risks associated with traditional practice. This method also promotes the adoption of smaller guide catheters, thus reducing the ischemic triggers during selective cannulation. Furthermore, it offers versatility in catheter selection and guidewire support, enhancing personalization to diverse patient anatomies and clinical scenarios.

By streamlining procedures and improving success rates, our technique represents a significant advancement in PCI via IMA grafts, promising safer and more efficient interventions for CABG patients.

Procedure-related stroke represents a major complication of transcatheter aortic valve replacement (TAVR). The Sentinel Cerebral Protection System is the only FDA-approved embolic protection device for TAVR and is intended for use via right radial access. As TAVR has become the preferred modality for aortic valve replacement, protection devices like Sentinel have been developed to reduce procedural complications; however, its use in aberrant aortic arch anatomy has not been previously reported. We present a case of successful Sentinel deployment and embolic protection via alternative left radial artery access in a patient with an aberrant right subclavian artery.

Hemolytic anemia following surgical mitral valve repair is rare, and the role of mitral transcatheter edge-to-edge repair (TEER) in its treatment is unknown. We present three cases of hemolytic anemia following surgical mitral valve repair treated with mitral TEER. All three patients experienced resolution of hemolysis after mitral TEER.