Treatment of heavily calcified coronary artery stenosis using 3.5 mm peripheral intravascular lithotripsy balloon: case series.

BACKGROUND: Prevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes. CASE SUMMARY: We report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment. DISCUSSION: Intravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.

Left Main Coronary Artery Thrombosis With Acute Myocardial Infarction: A Management Dilemma.

Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach.

Traumatic brachiocephalic pseudoaneurysm presenting as stroke in a seventeen-year-old.

We present a 17-y-old male who presented to the emergency room with left arm weakness along with slurred speech. On physical examination, he had stable vital signs with left facial weakness suggestive of lower motor neuron seventh nerve palsy. He was also noted to have a small pulsatile mass in the right infraclavicular region. Further questioning revealed that 3 mo earlier he had suffered blunt chest wall trauma during a football game with fracture-dislocation of the right clavicular head, which was managed conservatively. MRI of the brain showed right frontal cortical changes suggestive of infarct versus vasculitis or edema. Chest CT revealed a 2.5- to 3-cm pseudoaneurysm arising from the brachiocephalic artery, with thrombus formation, along with a surrounding 3 x 4.5 cm hematoma. The patient underwent a successful repair of the pseudoaneurysm with no further neurological sequelae. Traumatic pseudoaneurysm with thrombus formation is an extremely rare cause of stroke. It has been reported in association with the carotid artery, but to our knowledge, this is the first reported case with isolated innominate artery pseudoaneurysm. This case highlights the need for a broad differential when evaluating young patients with neurological deficits.

Coarctation of aorta in a 52-year-old female.

Coarctation of the aorta is a complex vascular lesion that usually originates distal to the left subclavian artery. It accounts for 5-10% of all congenital cardiovascular malformations and carries a high morbidity and mortality risk. Symptoms depend on the severity of the disease and other coexisting anomalies. Early in life, diagnosis is usually based on significant symptoms and physical findings. Many patients remain asymptomatic until adulthood, with most being diagnosed in the 2nd or 3rd decade. In this case report, we present a late diagnosis of aortic coarctation with a bicuspid aortic valve in a 52-year-old female. Our patient was relatively asymptomatic until she presented with chest discomfort, fatigue and dyspnea in her fifth decade of life. Based on the clinical presentation and the markedly elevated gradient, the patient was referred for corrective therapy.