Percutaneous intervention of chronic total occlusions (CTOs) can improve exercise capacity, symptoms and left ventricular function.¹ The parallel wire technique is a useful technique in recanalizing CTOs.² This technique utilizes a second wire to cross into the true lumen, while leaving the initial wire in a dissection plane or false lumen.² The initial wire is used as a guide for where not to cross, and also may act to occlude the entry point to the false lumen, thereby improving chances of true luminal wiring.

Case Report. A 37-year-old female in her seventh week of pregnancy presented to the emergency department after the onset of oppressive chest pain which had started 1 hour before. Her 8 previous pregnancies had terminated in abortion. She had no cardiovascular risk except for smoking, nor a history of alcohol or drug abuse. Her father had died of Leriche’s syndrome. A history of untreated peripheral obstructive arteriopathy was reported.
Clinical examination showed obesity. The patient was afebrile. Her blood pressure was 140/100 mmHg with a pulse of 100 beats per minute. Oxygen saturation determined by pulse oximetry was 100%. Nothing abnormal was found in the heart sounds.

Percutaneous left ventricular (LV) assist devices are increasingly being used during high-risk percutaneous coronary interventional (PCI) procedures.^1–4 These devices provide reliable short-term hemodynamic stability in complex cases during which the interventionist has the luxury of time to successfully carry out the procedure. The TandemHeart^® (Cardiac Assist, Inc., Pittsburgh, Pennsylvania) is a relatively recent introduction to the available percutaneous nonpulsatile centrifugal LV assist devices that can be used to support poorly functioning ventricles in a variety of high-risk interventions.

Complete heart block (CHB) due to the loss of a first septal perforator (FSP) following left anterior descending artery (LAD) stenting is uncommon, with few reported cases in the literature.^1,2 It usually occurs at the time of the procedure and is transient, typically resolving within 72 hours. This report describes the case of an elderly female who developed unheralded syncope secondary to CHB 2 days after uneventful percutaneous coronary angioplasty and stenting of the LAD.

Percutaneous occlusion of a patent ductus arteriosus (PDA) is actually a standard procedure for the treatment of this congenital heart defect. Different devices have been used for the last 20 years with high rates of success.^{1,2,4,8,11,13,14} A few exceptions include low-weight premature newborns and ductus endarteritis. Anatomic features of the ductus, the presence of an aortic ampulla and its minimal diameter are to be considered when the closing device is selected.⁶ We report the case of an adult patient with a PDA, a large aortic ampulla and mild-to-moderate pulmonary hypertension; the PDA was successfully closed using a Nit-Occlud^® PDA occlusion device (pfm AG, Cologne, Germany). Although this device is frequently used in the pediatric population, adult patients may present different challenges in proper management such as poor visualization, calcification and pulmonary hypertension.^3–5,7

Coronary artery fistulae (CAF) are direct precapillary communications which bypass the myocardial capillary network and connect a coronary artery to another vessel or cardiac chamber (cameral).¹ CAF are reported in 0.1–0.7% of patients undergoing coronary angiography and account for 13% of congenital coronary artery anomalies.^1,2 Acquired CAF occur as complications of myocardial infarction, traumatic accidents, invasive cardiac procedures or cardiac surgery.¹ Acquired CAF were present in 30% of 96 fistulae reported between 1985 and 1995.¹ Fistulae between arterial or venous bypass grafts and cardiac or noncardiac structures occur rarely after bypass grafting. To the best of our knowledge, we present the first case of fistula formation between a left circumflex (LCX) vein graft and the left atrium that was treated with percutaneous transcatheter embolization (PTE) with coiling.

Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. It is a major factor in restenosis following balloon angioplasty, but its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. We report on a patient with exertional angina that was caused by negative remodeling at the ostium of left anterior descending artery (LAD).

The undilatable lesion requiring rotational atherectomy is an uncommon occurrence with the current availability of noncompliant balloons and other methods of “focused-force” angioplasty. The use of noncompliant balloons, or a “buddy” cutting wire, and finally, the use of nonablation devices such as the Cutting Balloon Ultra (Boston Scientific Corp., Natick, Massachusetts) or the FX miniRAIL^™ catheter (Abbott Laboratories Inc., Abbott Park, Illinois) have all been described in previous reports.^2,3 Each of these plaque modifying therapies has had reported success in tackling severely calcified lesions that may be undilatable with conventional balloons. Rotational atherectomy remains the ultimate ablation and plaque modification therapy for truly undilatable lesions that are resistant to the above devices.

Variant angina is more frequently seen in East Asia than in the West. It may be associated with acute myocardial infarction, severe cardiac arrhythmia and sudden death. Most patients obtain sufficient relief by vasodilator drug management such as calcium antagonists and/or nitrates. However, it is well known that some patients experience angina refractory to such treatments.^1,2 Reportedly, about 5–30% of patients with variant angina do not get relief from anginal attacks with medical management. Previous studies showed that stent placement in spastic segments might be helpful for these patients.^3–6 However, these reports are limited to treatment of discrete and proximal fixed obstructive coronary artery lesions. Here, we report a case of multiple and diffuse spasm without coronary stenosis that resolved with full-coverage stent implantation.