Lesions in small vessels remain a challenge for PCIs. As many as 36% of patients undergoing PCI have vessels < 2.50 mm. Several studies have shown that as the vessel size decreases (from 4.0 to 2.5 mm) the probability of having a restenosis increases. We describe the case of a 51-year old man with multiple cardiovascular risk factors, treated for a long lesion with a 99% stenosis in the mid-segment of the LAD the day after a PCI of a significant, hazy, proximal occlusion of the ostium of the RCA.
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A patient with severe symptomatic mitral stenosis 22 years after surgical closure of an ostium secundum ASD had favourable characteristics for a percutaneous mitral commissurotomy. The inter-atrial septum puncture was guided by intracardiac echocardiography. The advancement of the transseptal catheter was hampered due to the thickness of the surgically-repaired septum. It became possible after predilatation of the ASD closure patch by the use of coronary angioplasty balloons over a 0.014” guidewire, previously guided into the left atrium through the transseptal puncture needle. Consequently, the mitral commissurotomy was successfully performed using the stepwise Inoue balloon technique.
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This report features a very rare event during carotid angioplasty in a 68-year-old male patient. The procedure was successful using a Fibernet embolic protection device, a Boston Scientific Carotid Wallstent and a 5.0mm balloon post-stent dilatation. After removal of the Fibernet device using the retrieval catheter, a torn 20cm linear PTFE fibre was identified. The patient’s post-procedure angiography was unremarkable and he has been symptom free to 30 days. A microscopic analysis revealed that the fibre consisted of PTFE (polytetrafluoroethylene), a common biocompatible fluoropolymer used in the construction of catheters, guidewires, and other components employed in percutaneous transluminal angioplasty.
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The presence of huge thrombi in coronary arteries during treatment of acute coronary syndromes is not uncommon in interventional cardiology and can lead to serious damage of the distal microcirculation compromising the immediate and long-term outcomes after percutaneous intervention. However, there is no consensus on the best strategy to approach this problem. We report a case of unstable angina, post MI, where a huge thrombus was detected in the presence of an open culprit artery. “Off label” use of intracoronary rt-PA, 5 days after the acute coronary event proved to be a safe and efficient therapeutic option to deal with this very complex scenario.
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A 54-year old male presented with an acute anterior MI and was treated with primary PCI. Due to a tortuous mid LAD artery, stent deployment was not possible using a Stabilizer™ wire plus a Balance Middleweight™ ‘buddy’ wire. However, using a Hi-Torque Wiggle Wire™ plus a Stabilizer™ ‘buddy’ wire, a 2.75x30 Endeavor™ drug eluting stent was successfully deployed with a good angiographic result. We discuss techniques to assist stent delivery in tortuous or calcified coronary anatomy, and consider the role of the Hi-Torque Wiggle Wire™ as an aid to stent delivery in this setting.
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Left coronary dominance due to the continuation of left anterior descending to form the posterior descending artery is a rare form of coronary anomaly observed in normal human hearts. We describe a patient presenting for coronary angiogram with this variant. A review of the literature and the clinical implications of this anomaly will be discussed.
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