Percutaneous coronary intervention in a rare case of Type V dual LAD.

Congenital coronary anomalies are rare and reported to occur in 0.64-1.3% of patients undergoing coronary angiography. The dual left anterior descending coronary artery (LAD) is a rare coronary anomaly defined as the presence of two LADs in the anterior interventricular sulcus (AIVS). It consists of a short LAD that ends high in the AIVS and a longer LAD that enters the distal AIVS and feeds apex. Percutaneous interventions are even more uncommon in dual LAD especially Type V LAD. Thus we describe an interesting case of percutaneous transluminal coronary angioplasty (PTCA) with stenting to Type V dual LAD in a patient with chronic stable angina who was refractory to maximal anti-anginal medications. Our case was unique for these aspects - 1)Type V dual LAD is rare.2)Ramus artery is present in fewer cases of dual LAD.3)Long LAD had a myocardial bridge.4)Few cases have been reported of PTCA with stenting to short LAD. .

Safety and performance of the Penumbra Liberty stent system in a rabbit aneurysm model.

BACKGROUND: Endovascular treatment of wide necked and large/giant intracranial aneurysms is challenging. The goal of this study was to evaluate the Liberty stent system in the rabbit elastase aneurysm model for 30, 90, and 180 days. METHODS: The Altes elastase model was used to create aneurysms in the right common carotid artery in New Zealand White rabbits. Safety was assessed by angiographic and histopathological data from treated wide necked aneurysms, treated subclavian arteries, and related vasculature immediately post-treatment and at scheduled end points. RESULTS: In this study, stenting of wide necked aneurysms demonstrated excellent results in all 35 animals. The Liberty could be tracked to the final position across an aneurysm neck precisely, without changing microcatheter position. After device deployment, no significant changes in vessel contour and no stent migration were observed. Coil mass was well supported in all aneurysms and high packing densities were achieved. In addition, follow-up angiograms showed stable coil masses and persistent occlusion in all animals, without any recanalization of the neck or aneurysmal sac. Furthermore, there was no evidence of coil compaction or protrusion of coil loop through the stent struts. None of the immediate post-coiling angiograms revealed evidence of vasospasm, dissection, or in-stent thrombosis. DISCUSSION: This animal study demonstrated promising results with the novel Liberty stent system. The Liberty showed consistent precise positioning and accurate deployment. The stent revealed good compatibility with embolic coiling procedures, while morbidity and mortality were negligible. In addition, persistent occlusion of aneurysms without recanalization or in-stent stenosis was observed at the 180 day follow-up.

Endovascular treatment in an unusual case of direct carotid cavernous fistula.

We describe a unique and unusual case of post-traumatic direct carotid cavernous fistula (CCF) with occluded proximal internal carotid artery and CCF filling from the contralateral side with retrograde cortical venous reflux. A male patient presented with intracranial haemorrhage due to cortical venous reflux. He was treated endovascularly through a contralateral approach by coiling the cavernous sinus and occluding the distal internal carotid artery at the fistulous site with glue.