ABSTRACT
Background: Coronary guidewire entrapment is not an uncommon complication of percutaneous coronary intervention, especially in the setting of complex coronary anatomy. Core wire fracture with uncoiling of spring wire represents a catastrophic complication, posing great technical difficulty in percutaneous retrieval. Case summary: The patient was a 50-year-old Asian male with ischaemic cardiomyopathy and severe left ventricular impairment. Coronary angiography showed severe left main and triple-vessel disease. Coronary artery bypass graft was declined due to high surgical risk. Percutaneous coronary intervention was performed under mechanical circulatory support. However, it was complicated with guidewire entrapment and unravelling with deformity of the newly implanted stent in the left anterior descending artery. The complication was successfully bailed out by rotational atherectomy and the novel intravascular ultrasound (IVUS) and enhanced stent visualization (ESV) system guided 'Twist-wire' technique. Complete wire fragments retrieval was achieved with excellent final angiographic and IVUS results immediately after procedure and at 4-month follow-up angiography. Discussion: This case represents a rare phenomenon of branch point protrusion of stent causing guidewire-stent edge entanglement. A novel 'Twist-wire' technique with IVUS and ESV guidance was highlighted to allow successful retrieval of fluoroscopically invisible uncoiled wire filaments.
ABSTRACT
A 71-year-old man who had undergone percutaneous transluminal coronary angioplasty (PTCA) in 2013 was admitted for unstable angina.
Subject(s)
Angina, Unstable , Hospitalization , Male , Humans , Aged , Angina, Unstable/diagnosis , Angina, Unstable/surgery , StentsABSTRACT
A 75-year-old man was admitted for non-ST-segment elevation myocardial infarction (NSTEMI).
Subject(s)
Non-ST Elevated Myocardial Infarction , Vascular Diseases , Male , Humans , Aged , HospitalizationABSTRACT
A 65-year-old man was admitted with non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography showed a left dominant system with severe and diffuse left anterior descending artery (LAD) disease, necessitating percutaneous coronary intervention (PCI).
Subject(s)
Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , Male , Humans , Aged , Percutaneous Coronary Intervention/methods , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/surgery , Coronary Angiography , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgeryABSTRACT
Nonelectrocardiogram (ECG)gated contrast computed tomography (CT) is commonly performed to exclude aortic dissection in chest pain patients. Besides evaluating the aorta for dissection flap, attention should be paid to the myocardium for areas of hypoenhancement that may suggest ischemia. Current models of multidetector CT enable assessment of myocardial perfusion with minimal motion artifact even without ECG gating. Transmural hypoenhancement with preserved wall thickness in a coronary distribution is highly specific for acute myocardial infarction. We report 2 cases of acute chest pain with initial nondiagnostic studies that underwent CT aortogram to exclude dissection. Instead, the CT showed myocardial hypoenhancement in left anterior descending artery territory. Myocardial hypoenhancement occurred before ST-segment elevation on ECG, suggesting that recognition of this important finding may lead to earlier revascularization decisions.
Subject(s)
Chest Pain/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Biomarkers/analysis , Cardiac-Gated Imaging Techniques , Contrast Media , Electrocardiography , Humans , MaleABSTRACT
This case illustrates the potential clinical usefulness of retrograde approach for selective visualization of distal vessels in a patient with multiple coronary chronic total occlusions and previous coronary artery bypass graft (CABG) surgery. By knowing in extreme detail the exact anatomy of the complex post-surgical coronary system, a successful treatment can be planned for the patient.
Subject(s)
Coronary Angiography/methods , Coronary Artery Bypass/adverse effects , Graft Occlusion, Vascular/diagnostic imaging , Out-of-Hospital Cardiac Arrest/diagnostic imaging , Out-of-Hospital Cardiac Arrest/surgery , Collateral Circulation/physiology , Coronary Artery Bypass/methods , Coronary Circulation/physiology , Electrocardiography/methods , Follow-Up Studies , Graft Occlusion, Vascular/surgery , Humans , Male , Middle Aged , Reoperation/methods , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Patency/physiology , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/therapyABSTRACT
The retrograde approach for percutaneous coronary intervention, using multiple arterial accesses for contralateral injection and large guiding catheters (7-8 Fr), has largely improved the success rate of recanalization of chronic total occlusions (CTOs). Radial approach and downsizing in this type of intervention are challenging. Our cases series demonstrates that in selected anatomies it is possible, feasible, and safe to perform single 6 Fr transradial guiding catheter retrograde recanalization of left-sided CTO via ipsilateral epicardial or septal collateral channels.
