[Rescue maneuver for entrapped stent in the coronary tree]. / Maniobra para rescate de stent atrapado en el árbol coronario.

We describe two patients in whom stents dislodged from the unexpanded balloon during angioplasty and remained trapped in the coronary tree. In one patient the stent was located in the curvature of the circumflex artery and, in the other patient, it was detected in the distal left main artery. Retrieval of the undeployed stents was accomplished in the first case after advancing a low profile balloon through the stent and, in the second case, after placing a second guidewire exterior to the stent. In both cases, the balloon was inflated distally and the stents were dislodged after pulling the balloon back towards the guiding catheter and then withdrawing the whole system.

Maniobra para rescate de stent atrapado en el árbol coronario / Rescue maneuver for entrapped stent in the coronary tree

Describimos el caso de dos pacientes que durante la angioplastia los stents se desprendieron del balón sin expandir y quedaron atrapados en el árbol coronario. En un paciente el stent quedó enclavado en la curvatura de la arteria circunfleja y en el otro paciente en el tronco común distal. Los stents se extrajeron en el primer caso tras avanzar un balón de bajo perfil a través del stent y en el otro tras colocar otra guía exterior al stent y situar un balón distal. En ambos casos se hinchó el balón distal a los stents y se logró desenclavar al retirar el balón hacia el catéter guía y después todo el sistema.

We describe two patients in whom stents dislodged from the unexpanded balloon during angioplasty and remained trapped in the coronary tree. In one patient the stent was located in the curvature of the circumflex artery and, in the other patient, it was detected in the distal left main artery. Retrieval of the undeployed stents was accomplished in the first case after advancing a low profile balloon through the stent and, in the second case, after placing a second guidewire exterior to the stent. In both cases, the balloon was inflated distally and the stents were dislodged after pulling the balloon back towards the guiding catheter and then withdrawing the whole system.

Anomalous left coronary artery arising from the right sinus of Valsalva causing angina pectoris.

We present a patient with an anomalous left coronary artery arising from the right sinus of Valsalva with effort angina. Diagnosis was made by coronary angiography. The course of the proximal segment was assessed with magnetic resonance imaging (MRI). An internal mammary artery was successfully grafted with symptomatic improvement.

Transesophageal atrial pacing stress echocardiography: difficulties in the performance and the interpretation of the test.

INTRODUCTION: Transesophageal atrial pacing stress echocardiography (TEAPSE) has been proposed as an alternative stress echo test in selected patients with known or suspected coronary artery disease. The purpose of this study was to determine: (1) whether TEAPSE could serve as a suitable provocative stress test in patients with stroke and (2) to investigate whether the pseudohypertrophy during TEAPSE that has been observed in experimental studies is also seen in the clinical setting. METHODS: TEAPSE at increasing heart rates was performed in 29 patients with stroke. The end-diastolic and end-systolic left ventricular (LV) wall/cavity circumferential area was traced and the ratio was calculated at each pacing stage, as well as the percent systolic thickening. RESULTS: A progressive increase in LV wall thickness was noted at high TEAPSE rates (from 1.31 +/- 0.21 mm at baseline to 1.47 +/- 0.27 mm at +50 beats/min of TEAPSE, p<0.05). The ratio wall/cavity area increased significantly at end diastole (from 1.65 +/- 0.36 at baseline to 2.12 +/- 0.49 at +50 beats/min, p<0.05). Percent systolic thickening was inversely correlated with the increase in wall thickness (r=-0.30, p<0.004) and the ratio wall/cavity area in diastole (r=-0.41, p<0.001). Feasibility of TEAPSE was 52% (15 of the 29 patients). CONCLUSIONS: The occurrence of pseudohypertrophy during TEAPSE in conjunction with the low feasibility rate makes the performance and the interpretation of the test problematic. Therefore, other modalities of stress echocardiography should be considered for routine clinical use and TEAPSE could be applied in specific circumstances when other modalities are either contraindicated or unavailable.

Stent implantation in variant angina refractory to medical treatment.

BACKGROUND: Vasospastic angina usually responds well to medical treatment. HYPOTHESIS: The present study describes our experience in patients who received a coronary stent because of recurrent variant angina refractory to medical treatment and evaluates stent implantation as an alternative treatment. MATERIALS AND METHODS: Between March 1998 and February 2005, recurrent variant angina was diagnosed in 22 patients admitted to our coronary care unit. Of these, five patients (22.7%), were refractory to pharmacologic treatment. Coronary angiography and coronary stents were indicated. Clinical follow-up was 29 +/- 6 months. RESULTS: Stenting was performed during diagnostic coronary angiography in two patients. In the other three patients, the stent was implanted 24-48 h later. We observed coronary spasm recurrences proximal or distal to the stent in four patients-two during the stent implantation procedure and the other two in the coronary care unit within 48 h post angioplasty. Three patients where treated with additional stenting and the fourth patient improved with pharmacologic treatment. During follow-up three patients remained asymptomatic. The fourth patient had diffuse in-stent restenosis in the third month, and the fifth patient showed a de novo lesion in the treated segment 2 years later. CONCLUSIONS: Stent implantation in patients with recurrent variant angina refractory to medical treatment may be an alternative treatment in carefully selected, clinically unstable patients. Spasm recurrences may occur in other segments of the treated artery, probably due to the diffuse nature of the disease. Immediate and continued surveillance is recommended because of the risk of adverse clinical events.