Retrograde Approach “Reverse CART Technique” with a Single Guiding Catheter for Chronic Total Occlusion of the Right Coronary Artery Via an Anomalous Left Circumflex Artery
- Wed, 3/30/11 - 11:21pm
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- 3416 reads
ABSTRACT: The retrograde approach has been shown to improve the success rate of percutaneous coronary intervention for coronary chronic total occlusion (CTO) when performed by highly experienced operators. We report a very challenging case of a retrograde approach by the “reverse controlled antegrade and retrograde subintimal tracking (CART) technique” with a single guiding catheter for a CTO of the right coronary artery via an anomalous left circumflex artery.
A Case of Extended Late-Phase In-Stent Restenosis After Implantation of a Bare-Metal Stent: Intravascular Ultrasound, Optical Coherence Tomography and Immunohistochemical Findings
- Wed, 3/30/11 - 10:46pm
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- 2700 reads
ABSTRACT: Although extended late-phase in-stent restenosis has been reported even after implantation of bare-metal stents (BMS), the data resolving the mechanism are sparse. We could obtain intravascular ultrasound, optical coherence tomography (OCT), and immunohistochemical findings by retrieving the material that prolapsed distal to the stent after balloon angioplasty for the in-stent restenosis 12 years after BMS implantation in a 76-year-old man. OCT showed homogeneous high signal in the distal segment and high signal accompanied by attenuation in the proximal segment.
Subclavian Balloon Venoplasty to Facilitate Lead Implant in Patient with Subclavian Venous Obstruction
- Wed, 3/30/11 - 10:20pm
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- 3082 reads
ABSTRACT: Implanting new leads for defibrillation or pacing leads could be problematic as a result of venous obstruction. Up to 50% of patients with pacemaker/implantable cardioverter defibrillator leads have an asymptomatic subclavian vein obstruction. Overcoming this obstruction could be very challenging. The current approaches of contralateral access, extraction and surgical intervention have significant drawbacks. This report presents an alternative approach that uses percutaneous subclavian balloon venoplasty successfully to regain venous access. We believe that this technique is safe and effective.
A Pain in the Leg Following Angiography
- Tue, 3/1/11 - 9:16pm
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- 3375 reads
ABSTRACT: This case illustrates a complication following deployment of the Angioseal® vascular closure device after routine angiography. The AngioSeal device is a percutaneous, bioabsorbable, collagen-based hemostatic plug deployed to seal the arterial puncture. We describe a 69-year-old gentleman who presented with unilateral leg cramps 1 week post-procedure. When seen in the cardiology clinic, a magnetic resonance imaging angiogram was requested, which showed a filling defect in the right popliteal artery.
Successful Use of an Extra-Long Hydrophilic-Coated Sheath in Enlarged Aorta to Overcome Extreme Tortuosity of Right Subclavian Artery Via Transradial Approach During Coronary Angiography
- Tue, 3/1/11 - 8:55pm
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- 3720 reads
ABSTRACT: The transradial approach (TRA) has gained popularity in recent years mainly because of the significantly decreased access-site complications and the greater patient comfort it offers. In this paper, we describe the successful use of an extra-long hydrophilic-coated sheath for coronary angiography via the TRA in the presence of a severely dilated ascending aorta in a patient with severe tortuosity of the right subclavian artery.
Successful Percutaneous Implantation of an Aortic Valve Stent Prosthesis in a Patient with a Mechanical Mitral Valve
- Tue, 3/1/11 - 8:37pm
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- 2324 reads
ABSTRACT: Percutaneous aortic valve replacement represents a minimally-invasive alternative to open heart valve replacement in high-risk patients. Interventional procedures are used in an increasing number of patients and indications are broadened as techniques further evolve. However, there are still many postulated contraindications for interventional aortic valve replacement. We report a case of successful transfemoral aortic valve replacement in a patient with a mechanical mitral valve, performed due to the patient’s refusal to accept blood transfusions.
Iatrogenic Dissection of the Anomalous-Origin Right Coronary Artery and Left Sinus of Valsalva
- Tue, 3/1/11 - 8:06pm
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- 2527 reads
ABSTRACT: Anomalous right coronary artery arising from the left sinus of Valsalva is a rare congenital abnormality. Percutaneous coronary intervention of the anomalous-origin right coronary artery can be challenging. Iatrogenic aortocoronary dissection is a rare and life-threatening complication. We present a case of aortocoronary dissection that occurred during angioplasty of the anomalous-origin right coronary artery.
Ruptured-Plaque-Like Appearance of Restenotic Tissue Following Sirolimus-Eluting Stent Implantation: An Optical Coherence Tomography Case Study
- Tue, 3/1/11 - 7:52pm
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- 2873 reads
ABSTRACT: A 57-year-old man was admitted for exertional angina pectoris. Coronary angiography showed a 99% stenosis in the left circumflex artery. A sirolimus-eluting stent was deployed in the culprit lesion and excellent angiographic results were obtained. Six-month routine follow-up coronary angiography showed a 90% focal restenosis at the proximal edge of the stent. At this site, optical coherence tomography imaging revealed restenotic tissue with a ruptured-plaque-like appearance overlying the stent struts.
The Sword of Damocles: An Illustrative Example of the Life-Saving Effect of the Collateral Circulation
- Tue, 3/1/11 - 5:34pm
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- 2432 reads
ABSTRACT: There is an ongoing debate on the effective importance of the collateral network, especially in the current era, where most patients with significant coronary artery disease are revascularized, be it percutaneously or surgically; thus, people may question a significant benefit of the coronary collateral circulation. However, the presented 61-year-old male patient demonstrates an unambiguous situation of a life-saving effect of the collateral circulation.
Simultaneous Aortic and Mitral Metallic Paravalvular Leaks Repaired Through One Delivery Sheath
- Fri, 1/28/11 - 7:48pm
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- 2316 reads
ABSTRACT: Paravalvular leaks (PVL) are a well-known complication after prosthetic valve surgery. Effective non-surgical repair techniques are being developed using several off-label transcatheter occlusive devices given that there is no unique technique applicable to repair each paravalvular leak. We describe a technique used to simultaneously repair several PVL percutaneously, in a patient with double mechanical prosthesis using a single delivery system, by taking advantage of specific anatomical factors and selecting the best applicable devices.
