Pub Date : 2025-06-27DOI: 10.1016/j.crmic.2025.100087
Nina S. Appareddy , Gabriel Areoye , Shan Tandon , Divyanshi Sood , Suhaib El Khatib , William Charles Stout , Kathleen Brown , George Gibson , Derar Albashaireh , Bhavith Aruni
Peri-device leak (PDL) following left atrial appendage occlusion (LAAO) is particularly problematic in patients with both high thromboembolic and bleeding risk. We present a case series of three patients with atrial fibrillation and high bleeding risk. All three patients underwent LAAO with a Watchman™ and were found to have PDL on follow-up imaging. All three patients underwent successful PDL closure with an Amplatzer™ duct occluder II device with no complications noted. These cases demonstrate that PDL closure can be safely and effectively performed via a plug-based approach. Imaging is critical in determining candidacy for and method of PDL closure.
{"title":"A case series of plug-based closure of peri-device leak after left atrial appendage occlusion","authors":"Nina S. Appareddy , Gabriel Areoye , Shan Tandon , Divyanshi Sood , Suhaib El Khatib , William Charles Stout , Kathleen Brown , George Gibson , Derar Albashaireh , Bhavith Aruni","doi":"10.1016/j.crmic.2025.100087","DOIUrl":"10.1016/j.crmic.2025.100087","url":null,"abstract":"<div><div>Peri-device leak (PDL) following left atrial appendage occlusion (LAAO) is particularly problematic in patients with both high thromboembolic and bleeding risk. We present a case series of three patients with atrial fibrillation and high bleeding risk. All three patients underwent LAAO with a Watchman™ and were found to have PDL on follow-up imaging. All three patients underwent successful PDL closure with an Amplatzer™ duct occluder II device with no complications noted. These cases demonstrate that PDL closure can be safely and effectively performed via a plug-based approach. Imaging is critical in determining candidacy for and method of PDL closure.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518485","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 : 2025-06-20DOI: 10.1016/j.crmic.2025.100086
Georgios E. Papadopoulos , Ilias Ninios , George Giannakoulas , Sotirios Evangelou , Andreas Ioannides , Vlasis Ninios
A 33-year-old male with congenitally corrected transposition of the great arteries (ccTGA), dextrocardia and situs solitus presented with dyspnea at rest, classified as New York Heart Association (NYHA) class IV, in the context of severe systemic atrioventricular valve (SAVV) regurgitation, and impaired systolic function of the systemic morphologically right ventricle. Due to high surgical risk, the Heart Team opted for a transcatheter edge-to-edge repair (TEER) using a PASCAL ACE device. The procedure successfully reduced regurgitation from severe to mild, resulting in symptomatic improvement and recovery to NYHA class I at six-month follow-up. This case highlights the feasibility of TEER as a minimally invasive alternative in selected patients with ccTGA and systemic AV valve regurgitation.
{"title":"Transcatheter edge-to-edge repair of the systemic atrioventricular valve in a patient with congenitally corrected transposition of the great arteries and dextrocardia","authors":"Georgios E. Papadopoulos , Ilias Ninios , George Giannakoulas , Sotirios Evangelou , Andreas Ioannides , Vlasis Ninios","doi":"10.1016/j.crmic.2025.100086","DOIUrl":"10.1016/j.crmic.2025.100086","url":null,"abstract":"<div><div>A 33-year-old male with congenitally corrected transposition of the great arteries (ccTGA), dextrocardia and situs solitus presented with dyspnea at rest, classified as New York Heart Association (NYHA) class IV, in the context of severe systemic atrioventricular valve (SAVV) regurgitation, and impaired systolic function of the systemic morphologically right ventricle. Due to high surgical risk, the Heart Team opted for a transcatheter edge-to-edge repair (TEER) using a PASCAL ACE device. The procedure successfully reduced regurgitation from severe to mild, resulting in symptomatic improvement and recovery to NYHA class I at six-month follow-up. This case highlights the feasibility of TEER as a minimally invasive alternative in selected patients with ccTGA and systemic AV valve regurgitation.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338742","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}
Anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp is a rare congenital anomaly with diverse clinical presentations and significant implications for patient management.
Case summary
This case series presents three unique cases of anomalous LMCA origin from the right coronary cusp, each with distinct clinical manifestations and management strategies. Case 1 involved an 82-year-old male presenting with heart failure symptoms, where coronary angiography revealed an anomalous LMCA with a retro-aortic course (benign), managed conservatively. Case 2 describes a 71-year-old female presenting with non-ST-segment elevation myocardial infarction (NSTEMI) due to a culprit right coronary artery (RCA) lesion, with the LMCA taking a pre-pulmonic course (benign), successfully treated with percutaneous coronary intervention (PCI) of the RCA. Case 3 details a 76-year-old male evaluated for exertional fatigue and abnormal stress test, found to have an anomalous LMCA with a malignant interarterial course, for which surgical revascularization was recommended, though the patient opted for conservative management.
Discussion
The series underscores the importance of recognizing LMCA anomalies and tailoring management strategies based on anatomical course and clinical presentation. Coronary computed tomography angiography (CTA) plays a pivotal role in delineating coronary anatomy and guiding management. Benign courses are managed conservatively, while malignant interarterial courses necessitate surgical consideration due to the increased risk of sudden cardiac death.
Conclusion
Anomalous origin of the LMCA from the right coronary cusp presents diagnostic and therapeutic challenges, requiring a multidisciplinary approach for optimal management. Early identification and accurate characterization of the coronary course are critical for guiding intervention and improving outcomes.
{"title":"Anomalous left main coronary artery originating from the right coronary cusp: A case series and clinical implications","authors":"Ghulam Mujtaba Ghumman , Adel Kanaan , Sanam Farooq , Abdul Baqi , F.N.U. Salman , Moaaz Baghal , Syed Sohail Ali","doi":"10.1016/j.crmic.2025.100084","DOIUrl":"10.1016/j.crmic.2025.100084","url":null,"abstract":"<div><h3>Background</h3><div>Anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp is a rare congenital anomaly with diverse clinical presentations and significant implications for patient management.</div></div><div><h3>Case summary</h3><div>This case series presents three unique cases of anomalous LMCA origin from the right coronary cusp, each with distinct clinical manifestations and management strategies. Case 1 involved an 82-year-old male presenting with heart failure symptoms, where coronary angiography revealed an anomalous LMCA with a retro-aortic course (benign), managed conservatively. Case 2 describes a 71-year-old female presenting with non-ST-segment elevation myocardial infarction (NSTEMI) due to a culprit right coronary artery (RCA) lesion, with the LMCA taking a pre-pulmonic course (benign), successfully treated with percutaneous coronary intervention (PCI) of the RCA. Case 3 details a 76-year-old male evaluated for exertional fatigue and abnormal stress test, found to have an anomalous LMCA with a malignant interarterial course, for which surgical revascularization was recommended, though the patient opted for conservative management.</div></div><div><h3>Discussion</h3><div>The series underscores the importance of recognizing LMCA anomalies and tailoring management strategies based on anatomical course and clinical presentation. Coronary computed tomography angiography (CTA) plays a pivotal role in delineating coronary anatomy and guiding management. Benign courses are managed conservatively, while malignant interarterial courses necessitate surgical consideration due to the increased risk of sudden cardiac death.</div></div><div><h3>Conclusion</h3><div>Anomalous origin of the LMCA from the right coronary cusp presents diagnostic and therapeutic challenges, requiring a multidisciplinary approach for optimal management. Early identification and accurate characterization of the coronary course are critical for guiding intervention and improving outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271038","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}
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the right coronary artery (RCA) remains technically challenging. Guide catheter-induced dissection is typically considered a serious complication. However, in rare cases, such events may paradoxically aid in successful revascularization.
Case Summary
We report the case of a 43-year-old male with prior coronary artery bypass grafting (CABG) and RCA CTO, who underwent unplanned investment PCI procedure. Immediately after guide catheter engagement, contrast injection revealed a proximal RCA dissection. Instead of terminating the procedure, this unintentional dissection enabled entry into the subintimal space and facilitated guidewire passage to the distal branches. Intravascular ultrasound (IVUS) confirmed entry into the false lumen. Serial balloon angioplasty was performed, restoring TIMI-III flow to the right posterior descending artery (RPDA) and right posterolateral artery (RPLA). Remarkably, the dissection did not extend to the aortic cusp, nor did it result in perforation or pericardial effusion. The case was deemed a successful investment procedure, with staged completion in 10 weeks when patient returned for definitive revascularization. Four overlapping stents were placed from ostial RCA to RPLA with excellent results.
Conclusion
While coronary dissection during CTO-PCI is conventionally viewed as a complication, in select scenarios it may facilitate revascularization. Recognizing and managing such outcomes requires careful intraprocedural assessment and expertise in complex PCI.
{"title":"When complications become opportunities: Guide catheter-induced dissection facilitating an unplanned investment strategy in chronic total occlusion PCI of the RCA","authors":"Ghulam Mujtaba Ghumman, Sidra Kalsoom, Mohammed Taleb, Syed Sohail Ali, Zaid Al-Jebaje","doi":"10.1016/j.crmic.2025.100085","DOIUrl":"10.1016/j.crmic.2025.100085","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the right coronary artery (RCA) remains technically challenging. Guide catheter-induced dissection is typically considered a serious complication. However, in rare cases, such events may paradoxically aid in successful revascularization.</div></div><div><h3>Case Summary</h3><div>We report the case of a 43-year-old male with prior coronary artery bypass grafting (CABG) and RCA CTO, who underwent unplanned investment PCI procedure. Immediately after guide catheter engagement, contrast injection revealed a proximal RCA dissection. Instead of terminating the procedure, this unintentional dissection enabled entry into the subintimal space and facilitated guidewire passage to the distal branches. Intravascular ultrasound (IVUS) confirmed entry into the false lumen. Serial balloon angioplasty was performed, restoring TIMI-III flow to the right posterior descending artery (RPDA) and right posterolateral artery (RPLA). Remarkably, the dissection did not extend to the aortic cusp, nor did it result in perforation or pericardial effusion. The case was deemed a successful investment procedure, with staged completion in 10 weeks when patient returned for definitive revascularization. Four overlapping stents were placed from ostial RCA to RPLA with excellent results.</div></div><div><h3>Conclusion</h3><div>While coronary dissection during CTO-PCI is conventionally viewed as a complication, in select scenarios it may facilitate revascularization. Recognizing and managing such outcomes requires careful intraprocedural assessment and expertise in complex PCI.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263887","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 : 2025-06-06DOI: 10.1016/j.crmic.2025.100081
Luai Madanat, Richard Bloomingdale, Ahmad Jabri, Michael Gallagher, Vishal Birk, Amr E. Abbas, John Young, Rakesh M. Suri
Mitral valve replacement in the setting of severe mitral annular calcification remains a high-risk intervention, often complicated by poor outcomes with both conventional surgical and transcatheter techniques. A hybrid open transcatheter mitral valve-in-MAC procedure utilizing an atrialized implantation strategy offers a promising alternative to minimize the risk of left ventricular outflow tract obstruction. Meticulous preoperative planning with cardiac CT is essential to guide procedural strategy and optimize outcomes.
{"title":"“Atrialized” minimally invasive transcatheter mitral valve-in-MAC replacement to prevent outflow tract obstruction","authors":"Luai Madanat, Richard Bloomingdale, Ahmad Jabri, Michael Gallagher, Vishal Birk, Amr E. Abbas, John Young, Rakesh M. Suri","doi":"10.1016/j.crmic.2025.100081","DOIUrl":"10.1016/j.crmic.2025.100081","url":null,"abstract":"<div><div>Mitral valve replacement in the setting of severe mitral annular calcification remains a high-risk intervention, often complicated by poor outcomes with both conventional surgical and transcatheter techniques. A hybrid open transcatheter mitral valve-in-MAC procedure utilizing an atrialized implantation strategy offers a promising alternative to minimize the risk of left ventricular outflow tract obstruction. Meticulous preoperative planning with cardiac CT is essential to guide procedural strategy and optimize outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231128","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 : 2025-06-04DOI: 10.1016/j.crmic.2025.100082
Nina S. Appareddy , Bradley Casey , Divyanshi Sood , Renuka Singh , Syed R. Zaidi , Manaquibb Khan , George Gibson , Bhavith Aruni , Derar Albashaireh
Transcatheter tricuspid valve-in-valve (TViV) replacement is an emerging alternative to repeat surgical intervention for patients with bioprosthetic tricuspid valve stenosis. We present two patients with a history of severe tricuspid regurgitation and bioprosthetic tricuspid valve replacement, one with a history of Ebstein's anomaly and the other with a history of blunt chest trauma. Both patients presented several years later with severe bioprosthetic tricuspid valve stenosis symptomatic with progressive lifestyle limiting dyspnea. Following multi-disciplinary discussion, they were both determined to be of high surgical risk and ultimately managed via a transcatheter approach with TViV replacement.
{"title":"TRI-umphant recovery: A case series of transcatheter tricuspid valve-in-valve replacement for bioprosthetic tricuspid valve stenosis","authors":"Nina S. Appareddy , Bradley Casey , Divyanshi Sood , Renuka Singh , Syed R. Zaidi , Manaquibb Khan , George Gibson , Bhavith Aruni , Derar Albashaireh","doi":"10.1016/j.crmic.2025.100082","DOIUrl":"10.1016/j.crmic.2025.100082","url":null,"abstract":"<div><div>Transcatheter tricuspid valve-in-valve (TViV) replacement is an emerging alternative to repeat surgical intervention for patients with bioprosthetic tricuspid valve stenosis. We present two patients with a history of severe tricuspid regurgitation and bioprosthetic tricuspid valve replacement, one with a history of Ebstein's anomaly and the other with a history of blunt chest trauma. Both patients presented several years later with severe bioprosthetic tricuspid valve stenosis symptomatic with progressive lifestyle limiting dyspnea. Following multi-disciplinary discussion, they were both determined to be of high surgical risk and ultimately managed via a transcatheter approach with TViV replacement.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241992","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 : 2025-06-01DOI: 10.1016/j.crmic.2025.100079
Alejandro Ricalde Alcocer , Oscar Ulises Preciado-Gutiérrez , Mariana García Villarejo , Mauricio Kuri , Gerardo Payró
Extrinsic left main coronary artery (LMCA) compression is a rare condition, often associated with pulmonary artery hypertension. We present the first reported case of extrinsic LMCA compression manifesting as syncope in a 35-year-old woman. Imaging confirmed significant LMCA compression due to pulmonary artery enlargement. Percutaneous coronary intervention with a third-generation stent successfully relieved the obstruction. At five-year follow-up, the stent remained patent without restenosis or fracture. This case highlights the importance of early diagnosis using multimodal imaging and demonstrates angioplasty as a safe, effective alternative for managing LMCA compression in high-risk patients.
{"title":"Extrinsic left main coronary artery compression in pulmonary hypertension with syncope debut","authors":"Alejandro Ricalde Alcocer , Oscar Ulises Preciado-Gutiérrez , Mariana García Villarejo , Mauricio Kuri , Gerardo Payró","doi":"10.1016/j.crmic.2025.100079","DOIUrl":"10.1016/j.crmic.2025.100079","url":null,"abstract":"<div><div>Extrinsic left main coronary artery (LMCA) compression is a rare condition, often associated with pulmonary artery hypertension. We present the first reported case of extrinsic LMCA compression manifesting as syncope in a 35-year-old woman. Imaging confirmed significant LMCA compression due to pulmonary artery enlargement. Percutaneous coronary intervention with a third-generation stent successfully relieved the obstruction. At five-year follow-up, the stent remained patent without restenosis or fracture. This case highlights the importance of early diagnosis using multimodal imaging and demonstrates angioplasty as a safe, effective alternative for managing LMCA compression in high-risk patients.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"7 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190156","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 : 2025-06-01DOI: 10.1016/j.crmic.2025.100080
William Camilleri, Joost Daemen, Nicolas M. Van Mieghem
The incidence of severe contrast allergy ranges from 0.01 to 0.04 % and can result in severe life threatening complications. We present a case of simultaneous TAVR for pure AR and LM PCI using zero contrast due to severe contrast allergy.
{"title":"Zero contrast concomitant transcatheter aortic valve and coronary intervention in a patient with severe contrast allergy","authors":"William Camilleri, Joost Daemen, Nicolas M. Van Mieghem","doi":"10.1016/j.crmic.2025.100080","DOIUrl":"10.1016/j.crmic.2025.100080","url":null,"abstract":"<div><div>The incidence of severe contrast allergy ranges from 0.01 to 0.04 % and can result in severe life threatening complications. We present a case of simultaneous TAVR for pure AR and LM PCI using zero contrast due to severe contrast allergy.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"7 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220960","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 : 2025-05-28DOI: 10.1016/j.crmic.2025.100078
Birgurman Singh , Christopher James Murray , Allan Santos Argueta , Usman Baber , Nirmal Kaur
We present a complex case of a 77-year-old high-surgical-risk patient with refractory angina due to severe in-stent restenosis (ISR) of a malpositioned right coronary artery (RCA) ostial stent protruding into the Aorta. Despite prior PCIs, including overlapping drug-eluting stents (DES), progressive ISR led to debilitating symptoms. Diagnostic imaging revealed an 8–10 mm aortic overhang of the RCA stent, complicating catheter engagement. A multidisciplinary team pursued percutaneous management to avoid high-risk CABG. Using femoral access and a temporary pacemaker, a malpositioned stent was successfully snared and removed. Subsequent OCT-guided PCI involved distal 3.0 × 32 mm and ostial 3.5 × 16 mm PROMUS DES deployment, optimized with intravascular imaging. The procedure restored TIMI III flow, resolving symptoms without complications. This case demonstrates the successful percutaneous retrieval and imaging-guided PCI for aortic-ostial ISR, highlighting the importance of careful planning, advanced interventional techniques, and a multidisciplinary approach to minimize the need for invasive surgery in high-risk patients.
{"title":"Erroneously deployed, old ostial RCA stent, overhanging in the aorta with symptomatic ostial severe ISR, snared, stented and successfully averted single vessel bypass","authors":"Birgurman Singh , Christopher James Murray , Allan Santos Argueta , Usman Baber , Nirmal Kaur","doi":"10.1016/j.crmic.2025.100078","DOIUrl":"10.1016/j.crmic.2025.100078","url":null,"abstract":"<div><div>We present a complex case of a 77-year-old high-surgical-risk patient with refractory angina due to severe in-stent restenosis (ISR) of a malpositioned right coronary artery (RCA) ostial stent protruding into the Aorta. Despite prior PCIs, including overlapping drug-eluting stents (DES), progressive ISR led to debilitating symptoms. Diagnostic imaging revealed an 8–10 mm aortic overhang of the RCA stent, complicating catheter engagement. A multidisciplinary team pursued percutaneous management to avoid high-risk CABG. Using femoral access and a temporary pacemaker, a malpositioned stent was successfully snared and removed. Subsequent OCT-guided PCI involved distal 3.0 × 32 mm and ostial 3.5 × 16 mm PROMUS DES deployment, optimized with intravascular imaging. The procedure restored TIMI III flow, resolving symptoms without complications. This case demonstrates the successful percutaneous retrieval and imaging-guided PCI for aortic-ostial ISR, highlighting the importance of careful planning, advanced interventional techniques, and a multidisciplinary approach to minimize the need for invasive surgery in high-risk patients.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178301","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 : 2025-05-15DOI: 10.1016/j.crmic.2025.100077
Giuseppe Andò, Alessio Villari, Giulia Cavolina, Olimpia Trio
Pericardial effusion is a common clinical finding that can arise from a wide range of etiologies, including infections, malignancies, autoimmune disorders, and iatrogenic causes. Management often requires pericardiocentesis, particularly when large effusions cause hemodynamic compromise or diagnostic clarification is necessary. While pericardiocentesis is generally a safe procedure when performed under imaging guidance, complications can still occur, particularly in elderly patients or those receiving anticoagulation therapy. One rare but important complication is pneumopericardium—the presence of air within the pericardial space—which may result in serious consequences such as cardiac tamponade or pericardial irritation if not promptly recognized and managed.
{"title":"Pneumopericardium after pericardiocentesis","authors":"Giuseppe Andò, Alessio Villari, Giulia Cavolina, Olimpia Trio","doi":"10.1016/j.crmic.2025.100077","DOIUrl":"10.1016/j.crmic.2025.100077","url":null,"abstract":"<div><div>Pericardial effusion is a common clinical finding that can arise from a wide range of etiologies, including infections, malignancies, autoimmune disorders, and iatrogenic causes. Management often requires pericardiocentesis, particularly when large effusions cause hemodynamic compromise or diagnostic clarification is necessary. While pericardiocentesis is generally a safe procedure when performed under imaging guidance, complications can still occur, particularly in elderly patients or those receiving anticoagulation therapy. One rare but important complication is pneumopericardium—the presence of air within the pericardial space—which may result in serious consequences such as cardiac tamponade or pericardial irritation if not promptly recognized and managed.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"7 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070135","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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