A 61-year-old man with chronic thromboembolic pulmonary hypertension underwent balloon pulmonary angioplasty (BPA) (1–3). Antegrade approach for a chronic total occlusion (CTO) lesion in an inside subsegmental branch of the left A9 pulmonary artery (A9b branch) was attempted (Figure 1A), but the hydrophilic and hard guidewire (tip load: 10 gf, Chevalier PL-X, Cordis, Tokyo, Japan) could not pass through this CTO lesion. Hence, another tight lesion in an outside subsegmental branch of the left A9 pulmonary artery (A9a branch) was treated (Figure 1B).
A 60-year-old woman who received thrombolytic treatment for inferoposterior myocardial infarction in a peripheral hospital was referred for rescue angioplasty for ongoing chest pain. Her relevant past history included active smoking, diabetes, and reversible cerebral vasoconstrictive syndrome. At the time of myocardial infarction, she was being investigated for symptoms suggestive of possible Raynaud’s phenomenon. Because of administration of thrombolytic medication, a right radial artery (RA) approach for coronary angiography (CA) was decided to avoid femoral artery–related bleeding complications. Allen’s test was “positive” (normal), and pre-procedure, 2.5 mg of verapamil and 200 μg of glyceryl trinitrate was administered in the RA. During the procedure, the patient developed severe spasm of the RA, and the procedure was completed using 5-F guide catheters. We administered further intraradial glyceryl trinitrate and verapamil to relieve the spasm along with intravenous midazolam and fentanyl. Acute lesions were noticed in both the right and left circumflex coronary arteries, which were treated with drug-eluting stents. Within the first 24 h after CA, the patient developed pain, numbness, and pallor of the distal right ring finger.
Among the rare complications after percutaneous coronary intervention, coronary artery aneurysms (CAA) reportedly have an incidence of 0.3% to 6.0%. The detection of CAAs vary from 3 days to up to 4 years after drug-eluting stent (DES) and from 6 days to up to 6 years after bare-metal stents (BMS) implantation. Associated factors include residual dissection and deep arterial wall injury caused by oversized balloons or stents, high-pressure balloon inflations, atherectomy, and laser angioplasty (1,2). Though the pathogenesis of CAA after DES, as well as after BMS, implantation has been studied, there seems to be neither sufficient literature nor adequate evidence of CAA after a bioabsorbable stent implantation. A 59-year-old male patient with exertional angina underwent percutaneous coronary intervention of the first obtuse marginal branch. After pre-dilation with a regular balloon, a 3.0 × 18-mm bioabsorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, Santa Clara, California) was positioned with good immediate results (Figure 1).
Abstract: Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy. Therefore, it is wrong to extrapolate current American College of Cardiology/American Heart Association Appropriate Use Criteria against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals. In this statement from the Interventional Section Leadership Council of the ACC, it is recommended that percutaneous coronary intervention should be considered in all patients with significant proximal coronary stenosis in major coronary arteries before TAVR, even though the indication is not covered in current guidelines.
Objective: The purpose of this study was to describe temporal trends and determine the comparative effectiveness of bivalirudin versus unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Objectives: The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients.
Objectives: The goal of this study was to describe early and midterm outcomes of extremely premature newborns (EPNs) who underwent transcatheter echocardiographically guided patent ductus arteriosus (PDA) closure.
A 51-year-old woman presented to the emergency department with a 3-week history of intermittent palpitations, dyspnea, and substernal chest pain lasting 5 to 10 min with spontaneous resolution. She remained hemodynamically stable, and an electrocardiogram showed a 1.5-mm ST-segment elevation in lead V2 along with sinus tachycardia. Given the persistence of her symptoms, she underwent diagnostic angiography. Upon coronary vessel engagement with the coronary catheter, there was severe left main and right coronary ostial vasospasm, with dampening of the blood pressure tracings, both subsequently relieved with the administration of sublingual and intracoronary nitroglycerin (Figure 1).
A 78-year-old man was hospitalized for heart failure with severe aortic stenosis. He had a history of cardiac surgery with coronary artery bypass surgery and mitral annuloplasty. Our heart team decided that he was a candidate for transcatheter aortic valve replacement (TAVR) on the basis of his background. A 29-mm CoreValve (Medtronic, Minneapolis, Minnesota) was implanted via the femoral artery without any significant complications (Figure 1A). Contrast-enhanced multidetector computed tomography (MDCT) using a 256-slice scanner (Brilliance iCT, Philips Medical Systems, Eindhoven, the Netherlands) was performed to examine the interference between a previously sutured mitral ring and CoreValve 7 days after the TAVR procedure.
A 63-year-old man, with a past medical history significant for hypertension, dyslipidemia, coronary disease, and left ventricular dysfunction (left ventricular ejection fraction 45%), was anticoagulated for atrial fibrillation due to a high thromboembolic risk (CHA2DS2-VASc = 3). Under rivoroxaban, the patient experienced several recurrent episodes of lower gastrointestinal bleeding caused by hemorrhoids. Despite rubber band ligation and argon laser therapy, major bleeding relapsed every time anticoagulation was resumed.
A 62-year-old female tourist without significant cardiovascular risk factors presented with acute chest pain. She came from the United States to Japan 5 days earlier by plane. When she had been transferred to our emergency department by ambulance, she was in cardiogenic shock, and her initial blood pressure was 63/48 mm Hg. The electrocardiogram (ECG) demonstrated widespread ST-segment depression plus ST-segment elevation in lead aVR (Figure 1A). The echocardiogram showed severe hypokinesis of left ventricular (LV) wall motion with paradoxical interventricular septum.
Abstract: The development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. The authors review contemporary transseptal puncture indications and techniques and provide a step-by-step approach to challenging transseptal access and procedural complications.
Objectives: The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD).
Objectives: The study sought to determine the incidence, predictors, characteristics, and outcomes of repeat revascularization during 5-year follow-up of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) trial.
Objectives: The aim of this study was to identify histological features that correlate with terms commonly used to describe optical coherence tomographic (OCT) and optical frequency-domain imaging (OFDI) images of stented vessels, by means of a histopathological validation study using stented human coronary arteries.
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