ABSTRACT
Percutaneous closure of coronary fistulas can be a challenge, given the tortuosity and the small caliber of the anomalous vessel. The microvascular plugs (MVP) are polytetrafluoroethylene-coated nitinol devices designed to perform embolization of small peripheral vessels. Its reduced profile allows the release of the device through microcatheters, facilitating the intervention. We present three cases of coronary fistulas in adults, percutaneously closed through radial access using these devices.
ABSTRACT
No-reflow phenomenon is frequent in patients with ST-segment elevation myocardial infarction (STEMI) and has proven to be a strong predictor of mortality. Local fibrinolytic infusion with distal coronary occlusion (previously described as "marinade technique") can be useful in patients with acute myocardial infarction and intraluminal thrombus refractory to aspiration enabling the local effect of the drug, directly applied inside the thrombus, while protecting the microvasculature with prolonged inflation of a distal balloon. We present the early experience of four patients with inferior acute myocardial infarction and high thrombus burden successfully treated with marinade technique in one center.
ABSTRACT
Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.
Subject(s)
Coronary Vessel Anomalies , Percutaneous Coronary Intervention , Sinus of Valsalva , Cardiac Catheterization , Catheters , Coronary Angiography , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Humans , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Sinus of Valsalva/surgery , StentsABSTRACT
BACKGROUND: Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might present a challenge in the diagnostic and therapeutic management. CASE SUMMARY: We present a patient with chest pain whose initial tests were normal, but coronary artery fistulae were found. Single-photon emission computed tomography test showed ischaemia due to coronary artery fistulae and cardiac computed tomography helped in the planning of the percutaneous closure. DISCUSSION: CCT is emerging as an optimal non-invasive tool to characterise the morphology and course of coronary artery fistulae and may be essential for its accurate diagnosis and planning for percutaneous closure.
ABSTRACT
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute coronary syndrome, typically in young patients without classical cardiovascular risk factors. Although in SCAD the conservative management is preferable, in cases with complete occlusion of the artery an invasive treatment may be required. In such cases, the goal of the percutaneous intervention should be to restore the connection between the true and false lumen recovering the distal flow of the vessel. CASE SUMMARY: A young man was admitted with acute chest pain and ST segment elevation in precordial v3-v6 leads. An emergent coronary angiogram showed an abrupt occlusion of middle left anterior descending artery compatible with SCAD. A microcatheter was advanced distally into the artery and pulled back with continuous contrast injection through the catheter, restoring the distal flow with a residual spiroid intimal flap and with relief of the chest discomfort. A computed tomography performed during admission showed complete resolution of the lesion. DISCUSSION: In SCAD with complete occlusion of the vessel, the 'pull-back technique' with continuous vigorous injection of contrast through a distal microcatheter may be effective to restore the distal flow enabling the healing of the artery at follow-up and avoiding the stent implant.
Subject(s)
Humans , Aged , Aneurysm, False , Aortic Aneurysm , Chest Pain , Aortic Valve , Aorta, ThoracicSubject(s)
Aortic Aneurysm/surgery , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/etiology , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/etiology , Postoperative Complications/diagnostic imaging , Aged , Coronary Aneurysm/surgery , Coronary Angiography , Coronary Thrombosis/surgery , Echocardiography , Female , Humans , Postoperative Complications/etiology , Postoperative Complications/surgeryABSTRACT
Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.
Subject(s)
Coronary Vessels , Myocardial Infarction , Abciximab , Antibodies, Monoclonal , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Fibrinolysis , Humans , Immunoglobulin Fab Fragments , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors , Platelet Glycoprotein GPIIb-IIIa Complex , Treatment OutcomeABSTRACT
Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.
Subject(s)
Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Punctures , Retrospective Studies , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.
Subject(s)
Calcinosis/diagnosis , Computed Tomography Angiography/methods , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Coronary Vessels/diagnostic imaging , Registries , Aged , Female , Follow-Up Studies , Humans , Male , Prognosis , Retrospective Studies , Risk FactorsSubject(s)
Aneurysm, False , Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Aneurysm, False/surgery , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/surgery , Humans , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Coronary Stenosis/diagnostic imaging , Constriction, Pathologic , Coronary Angiography , Coronary Vessels/diagnostic imaging , Predictive Value of Tests , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
Ebstein anomaly is a congenital disease frequently associated with atrial septal defects, which can generate a right-to-left shunt, leading to systemic desaturation and right ventricular failure. We describe the case of a 68-year-old man with central cyanosis due to Ebstein anomaly and a patent foramen ovale. An atrial septal occluder was initially implanted after having performed prolonged test occlusion of the interatrial communication. In this case, device embolization occurred due to high right pressure. Percutaneous closure of atrial septal defects in the presence of a right-to-left shunt can offer a significant clinical improvement in selected cases. In patients with Ebstein anomaly, the implantation of atrial septal defect closure devices may be desirable, due to the larger size of the waist, which may provide better stability in the event of an increase in right pressure.
Subject(s)
Cardiovascular Abnormalities , Ebstein Anomaly , Foramen Ovale, Patent , Septal Occluder Device , Aged , Ebstein Anomaly/complications , Foramen Ovale, Patent/complications , Humans , Hypoxia , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Heart Valve Prosthesis/adverse effects , Mitral Valve Stenosis/therapy , Dabigatran/therapeutic use , Thrombosis/drug therapy , Prosthesis Failure/adverse effects , Reoperation/methods , Endovascular Procedures/methodsABSTRACT
We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.