Successful double-layer metal stents rotational ablation under 2-dimensional and 3-dimensional optical coherence tomography guidance: a case report.

BACKGROUND: Stent ablation with rotational atherectomy has been considered a bail-out strategy for the treatment of severe stent underexpansion. Only a few reports have yet shown rotational ablation for double-layer metal struts. CASE PRESENTATION: We present a case of 80-year-old female patient presented to our hospital because of worsening effort angina. Coronary angiography revealed severe in-stent restenosis in the proximal left anterior descending artery. Optical coherence tomography (OCT) examinations found that severe stenosis occurred at the overlap region with 2-layer underexpanded stents and circumferential calcification beneath them. Under the guidance of 2-dimensional (2D) and 3-dimensional (3D) OCT, we successfully performed percutaneous coronary intervention (PCI) of this lesion after adequate stent ablation, high-pressure balloon dilatation, and subsequent everolimus-eluting stent implantation. The patient recovered well uneventfully and discharged from hospital 7 days later. No restenosis occurred after 12 months. CONCLUSIONS: We report a very rare case of in-stent restenosis due to double-layer underexpanded stents. The entire percutaneous coronary intervention procedure was performed step by step under the guidance of high-resolution OCT. Our findings highlight the specific value of 2D and 3D OCT guidance in double-layer stents rotational ablation.

A confused ECG with multiple rhythms caused by atrial premature contractions: A case report.

INTRODUCTION: Atrial premature contractions (APCs) are commonly encountered in clinical practice. The APCs may influence heart conduction system and induce other arrhythmia. The disorder of atrioventricular conduction is related to electrophysiological phenomena, difficult to understand and diagnose. CASE REPORT: We presented a 15-year-old male patient whose baseline electrocardiogram (ECG) was confused with multiple rhythms. Electrophysiological study results showed sinus rhythm with nonconducted APCs in bigeminal rhythm. Nonconducted APCs were blocked without H wave. Some APCs conducted to ventricle with longer AH interval and HV interval. When APCs were abolished by radiofrequency ablation, this patient was free from any arrhythmia during follow-up. CONCLUSION: We considered that the basic rhythm of the baseline ECG was sinus rhythm with atrial bigeminy rhythm and narrow QRS extrasystoles (junctional); some APCs were blocked and some APCs conducted to ventricle with aberrant QRS complexes. The phenomenon of baseline ECG was caused by the APCs.