Volume 24 - Issue 2 - February 2012

Successful Transradial Retrieval of Broken Catheter Fragment During Transradial Coronary Angiography

Abstract: Intravascular fracture of angiographic catheters is very uncommon, but it happens. Removal of an intravascular foreign body may require surgical intervention or non-surgical retrieval necessitating additional vascular access (mostly via femoral artery). We describe a case in which the diagnostic catheter was broken. We were able to pass two guidewires (0.035-inch guidewire and 0.014-inch standard percutaneous transluminal coronary angioplasty guidewire) through the fragment.

Saphenous Vein Graft Intervention: A Review

Abstract: Saphenous vein grafts are prone to degeneration and occlusion. Vein graft disease continues to be a significant problem in maintaining long-term benefits after coronary artery bypass surgery. The neointimal hyperplasia and aggressive atherosclerosis that occur in saphenous vein grafts make interventions particularly challenging due to plaque embolization and the no-reflow phenomenon. This review discusses the pathophysiology of vein graft disease and the various percutaneous strategies that have been applied to manage vein grafts.

Successful Use of Glycoprotein IIb/IIIa Inhibitor, Heparin, and IABP During PCI in a Post-Neurosurgical Patient with STEMI and Cardiogenic Shock Due to Very Late Bare-Metal Stent Thrombosis

Abstract: Stent thrombosis is not unusual in a post-operative setting. Use of heparin, aspirin, clopidogrel, and glycoprotein (GP)  IIb/IIIa inhibitors in this setting needs to be balanced because of the increased risk of perioperative bleeding. This is of special concern in neurosurgery, where postoperative mass effect from bleeding in a closed space is a serious risk.

Coronary Imaging and Intervention During Cardiovascular Collapse: Use of the LUCAS Mechanical CPR Device in the Cardiac Catheterization Laboratory

Abstract: The management of cardiac arrest during coronary angiography and intervention presents substantial challenges. Patients presenting with ST-segment elevation myocardial infarction or following resuscitation from cardiac arrest are at greatest risk and may represent a significant portion of patients in some centers. Timely and effective cardiopulmonary resuscitation (CPR), with manual chest compressions is the primary mode of support though novel circulatory assist devices may have some role.

An Unusual Complication After Coronary Catheterization

ABSTRACT: Valvular complications after coronary catheterization are extremely rare and are seldom reported in the literature. We report a patient who experienced acute traumatic aortic regurgitation after repeated coronary transcatheter procedures. Despite clinical stabilization under medical treatment, his clinical course led to an aortic-valve replacement.

J INVASIVE CARDIOL 2012;24(2):E22-E23

Transcatheter Closure of a Large Aortopulmonary Window with Severe Pulmonary Arterial Hypertension Beyond Infancy

ABSTRACT: A patient presented with a large aortopulmonary window and significant pulmonary hypertension, and underwent successful closure with muscular ventricular septal occluder (ShenZhen Lifetech Scientific Inc.) without complications in short-term follow-up.

J INVASIVE CARDIOL 2012;24(2):E24-E26

Deferring Coronary Stenting for Myocardial Bridging by Fractional Flow Reserve and Optical Coherence Tomography

ABSTRACT: Deciding how to treat acute myocardial infarction (MI) with myocardial bridge is difficult because stent fracture and early restenosis are frequently reported. We present a 50-year-old female patient with acute MI and myocardial bridge. Optical coherence tomography (OCT) and fractional flow reserve were used to reach a decision on treatment.  

J INVASIVE CARDIOL 2012;24(2):E27-E29

Novel Use of a GuideLiner Catheter to Visualize Distal LAD After LIMA Anastomosis in Selective Coronary Angiography

ABSTRACT: We report a case of GuideLiner catheter use during transradial intervention for selective coronary angiography of the distal left anterior descending artery (LAD), beyond the left internal mammary artery (LIMA) anastomosis. The lesion within the LAD was located distal to the anastomosis of a very tortuous LIMA, otherwise unable to be visualized due to competitive flow from the LIMA. Stenting by way of the LIMA could not be performed due to this severe tortuosity as well.