Compression syndrome as a complication of percutaneous coronary intervention

Coronary artery perforation is a rare complication of percutaneous coronary intervention with potentially fatal consequences. A case of perforation occurring during percutaneous coronary intervention to a saphenous vein graft, complicated by the subsequent development of a compressive right atrial hematoma, is reported. The management of the case is described, and similar case reports in the literature are reviewed. The role of imaging in making the initial diagnosis and formulating an appropriate management strategy is emphasized.     

Percutaneous treatment of dissection of the ascending aorta occurring as a complication during coronary angioplasty of a saphenous vein bypass graft

Aortocoronary dissection can occur as a complication of angioplasty of native coronary arteries. This case report is of aortic dissection occurring as a complication of percutaneous coronary intervention of proximal anastomoses of a saphenous vein bypass graft. The aortic dissection that had progressed retrogradely into the ascending aorta was treated percutaneously by stenting in the saphenous vein graft with a membrane-covered stent.     

Ultrafast computed tomography in management of post-bentall aortic root pseudoaneurysm repair

A giant pseudoaneurysm adjacent to the sternum was diagnosed in a patient who had undergone aortic root replacement with use of the Bentall operation 10 years earlier. Electron-beam computed tomography showed that the right coronary artery, which could not be seen on angiography, originated from the pseudoaneurysm itself. At reoperation, we found that both coronary ostia were detached and that the right coronary ostium was totally detached. The source of the right coronary artery blood flow was the pseudoaneurysm itself The defect at the left coronary artery attachment site was repaired primarily. A vein graft was interposed between the ostium of the right coronary artery and the native aorta, distal to the graft anastomosis.     

Novel approach to stenting the left anterior descending coronary artery through a retrograde approach via the left internal mammary artery graft in a patient with occlusion of the coronary ostium from a prior aortic valve replacement

Total occlusion of both coronary ostia is a rare and potentially life-threatening complication following surgical aortic valve replacement. This report presents a case of a patient with known total occlusion of both coronary artery ostia following combined coronary artery bypass graft surgery and aortic valve replacement who underwent successful percutaneous coronary intervention through a retrograde approach.     

Anterior ECG changes following iatrogenic dissection of the right coronary artery into the aortic root: Exclusion of left coronary obstruction with transoesophageal echocardiography

One of the most troublesome complications of percutaneous coronary intervention (PCI) or angiography is retrograde dissection of the artery into the aortic root. We report a case involving the right coronary artery (RCA) which was treated with prompt deployment of stents. Recurrent chest pain and ST segment elevation in V_2–4 mimicked the ECG appearance of acute anterior infarction and prompted concern that the dissection had extended to impair flow in the left coronary artery (LCA). Transoesophageal echocardiography (TOE) demonstrated that the aortic root dissection had been contained and that the LCA was not compromised.     

Angina pectoris in a case of Takayasu's disease: revascularization by coronary ostioplasty and bypass grafting

A young man with Takayasu's disease had severe right and leftcoronary ostial stenoses. Severe angina was relieved by operationat which the right coronary ostium was enlarged by a pericardialpatch extending across the stenosis from aorta to coronary artery;the aortic end of a vein graft to the left coronary artery wasattached to this patch. This technique may reduce the risk ofrecurrence of ostial stenosis or of stenosis at graft origins.     

Angina pectoris in a case of Takayasu's disease: revascularization by coronary ostioplasty and bypass grafting

A young man with Takayasu's disease had severe right and leftcoronary ostial stenoses. Severe angina was relieved by operationat which the right coronary ostium was enlarged by a pericardialpatch extending across the stenosis from aorta to coronary artery;the aortic end of a vein graft to the left coronary artery wasattached to this patch. This technique may reduce the risk ofrecurrence of ostial stenosis or of stenosis at graft origins.     

Spontaneous late thrombolysis of an occluded saphenous vein graft subsequent to acute myocardial infarction treated with percutaneous coronary intervention to the native culprit vessel

A 67-year-old male with prior history of myocardial infarction and coronary artery bypass grafting (individual vein grafts to the left anterior descending artery [LAD] and right coronary artery) presented with an acute anterior ST elevation myocardial infarction and cardiogenic shock. The vein graft to the LAD was occluded with heavy thrombus burden and there was severe native CAD. Given the degree of thrombus burden and other anatomic considerations, percutaneous intervention with stenting was performed to the native proximal LAD. Three months later, after complaining of atypical chest pain, repeat angiogram revealed a spontaneous widely patent vein graft to the LAD and occluded proximal LAD.     

Chronic total occlusion recanalization for myocardial infarction

An 84‐year‐old patient with prior coronary artery bypass surgery presented with non‐ST segment elevation acute myocardial infarction. The culprit lesion was at the distal anastomosis of a saphenous vein graft (SVG) to the right posterior descending artery. The proximal right coronary artery was chronically occluded. Because of significant disease both proximal and distal to the SVG anastomosis, percutaneous intervention of the SVG carried high risk for acute vessel closure. The native right coronary artery chronic total occlusion was successfully recanalized, enabling complete revascularization of the right coronary artery. The SVG was then occluded using an Amplatzer vascular plug.     

Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.

The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000.     

Stent treatment of an aortocoronary dissection during percutaneous coronary intervention. A case report and brief literature review

Aortocoronary dissection as a complication of diagnostic angiography or percutaneous coronary intervention is a rare occurrence. We describe a patient, in whom retrograde aortic dissection appeared during percutaneous coronary intervention to the right coronary artery, which was successfully treated by a 4-stent implantation.     

Superior vena cava syndrome: a rare complication of saphenous vein graft stenting: a case report

Rupture of coronary artery bypass graft during percutaneous coronary intervention is a rare but serious complication. These perforations are often associated with myocardial infarction, pericardial tamponade, immediate or delayed, emergency bypass surgery and even death. We report an interesting case where perforation of a saphenous vein graft occurred after direct stenting, resulting in a very rare complication of superior vena cava (SVC) syndrome.     

Coronary Ostial Stenosis after Aortic Valve Replacement: Successful Treatment of 2 Patients with Drug-Eluting Stents

Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention.Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option.Key words: Angioplasty, transluminal, percutaneous coronary; aortic valve/surgery; cardiac surgical procedures/adverse effects; coronary artery disease/etiology/prevention & control; coronary stenosis/diagnosis/etiology/therapy; heart valve prosthesis implantation/adverse effects; iatrogenic disease/prevention & control; perfusion/adverse effects/instrumentation; postoperative complications/therapy; treatment outcomeCoronary ostial stenosis is a rare but potentially serious postoperative sequela of aortic valve replacement (AVR). Ostial stenosis can occur in the left main coronary artery (LMCA) or in the right coronary artery (RCA). The condition, first described by Roberts and Morrow in 1967,¹ is believed to occur after 1% to 5% of AVR procedures.^2–7 No underlying cause has been determined. The clinical symptoms of coronary ostial stenosis are usually severe and can appear from 1 to 6 months postoperatively.^8,9 Although the typical treatment is coronary artery bypass grafting (CABG), patients have been successfully treated by means of percutaneous coronary intervention (PCI).^10–15 Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after AVR, discuss their PCI treatment, and offer our conclusion regarding the feasibility of PCI in the treatment of coronary ostial stenosis.     

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.

We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.     

Percutaneous treatment of catheter‐induced dissection of the left main coronary artery and adjacent aortic wall: A case report

Left main coronary artery dissection complicating selective coronary angiography is uncommon. Moreover, aortic root dissection associated with coronary intervention is underreported and may require urgent surgical intervention. During percutaneous coronary angioplasty of a catheter‐induced left main coronary artery dissection, retrograde dissection of the adjacent aortic root occurred. Both were successfully treated by stenting of the left main coronary artery. Cathet. Cardiovasc. Intervent. 49:86–89, 2000. © 2000 Wiley‐Liss, Inc.     

Primary percutaneous coronary intervention for ST-elevation myocardial infarction in a patient with a single coronary artery arising from the right aortic sinus

We report the first case of primary percutaneous coronary intervention (PPCI) in a patient with a single coronary artery arising from the right aortic sinus. With the increasing availability of PPCI, more patients with coronary artery anomalies will undergo this procedure. This report highlights both the feasibility and safety of PPCI in patients with even the rarest of coronary artery anomalies.     

Successful endovascular treatment of iatrogenic coronary artery dissection extending into the entire ascending aorta

Iatrogenic acute dissection of the ascending aorta during percutaneous coronary intervention occurs rarely. Localized aortic dissections may be treated by sealing the entry with a coronary stent. However, extensive dissections may require a surgical intervention. A case of iatrogenic coronary dissection with extensive propagation into the ascending aorta during angioplasty of the right coronary artery is presented. The aortic dissection was successfully treated by stenting at the right coronary artery ostium. Follow-up computed tomography and coronary angiography showed complete resolution of aortic dissection.     

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts

Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.

Keywords: aneurysm;  pseudoaneurysm;  saphenous vein grafts;  coronary artery bypass graft     

Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations

While coronary artery bypass grafting remains an essential component of revascularization therapy, the use of venous conduits in the form of saphenous vein grafts is associated with a number of late sequelae, including graft stenosis and occlusion. The recognition of saphenous vein graft aneurysm, typically a late complication, may be associated with adverse outcomes. We describe the percutaneous therapy of saphenous vein graft aneurysm, utilizing contemporary devices, including newer generation covered stents, and the use of devices more commonly used in peripheral vascular intervention, reflecting the dilated nature of vein grafts. Saphenous vein graft aneurysm can be successfully treated with percutaneous therapy, avoiding the risk of repeat sternotomy and associated morbidity. The use of new generation covered stents has not been previously well reported; however, it may have an important role in the treatment of coronary artery and saphenous vein graft aneurysm. Awareness of the role of covered stents used in both coronary and peripheral intervention and the advantages of new generation devices are essential to allow optimal therapy of this uncommon, late complication. The role and potential benefits of new generation covered stents are discussed with a review of the existing literature.