Embolization from Angiographic Catheter during Angiography Simulating Vascular Spasm

ABSTRACT The initiating event in the pathogenesis of acute coronary thrombosis, especially the role played by vasospasm, remains controversial. Recently an angiographic sequence of events has been reported which should conclusively prove that spasm of a normal coronary artery might lead to occlusive thrombosis. The patient survived, and thus this conclusion was reached without morphological verification. The present report describes an almost identical angiographic sequence of events in a cerebral artery initially interpreted in the same way: spasm leading to thrombosis. The patient died, and an embolus derived from the angiographic catheter was found at postmortem examination exactly where angiography had shown “spasm”. A “catheter embolus” simulating vascular spasm could as well explain the basic angiographic findings in the previously reported case. Thus, it still remains to be proved that spasm of a normal artery may lead to occlusive thrombosis.     

Successful Management of an Iatrogenic Left Main Coronary Artery Occlusion during Coronary Angiography: A Case Report and Brief Review

Abrupt left main coronary artery (LMCA) closure during diagnostic coronary angiography is a rare but catastrophic event with a poor prognosis. Emergency reperfusion of the LMCA with hemodynamic support should be the primary goal in patients with acute LMCA occlusion. Emergency coronary artery bypass graft surgery may be effective but time-consuming, and carries the risk of extensive and irreversible myocardial damage. We describe a case of abrupt closure of the LMCA due to plaque rupture by a diagnostic angiographic catheter without visible dissection following coronary angiography that was successfully treated with bail-out stenting during cardiopulmonary resuscitation.     

Embolization of a Giant Splenic Artery Aneurysm with Only Proximal Coil Embolization: A Case Report

Traditionally giant splenic artery aneurysms have been treated by surgery. We present the first case report of a patient with a giant splenic artery aneurysm that was successfully treated exclusively by transcatheter technique with only proximal embolization. Potentially, this technique makes more patients eligible for endovascular therapy and reduces operative time.     

Case Report: Osteoporosis as a Complication of Chronic Anorexia Nervosa in a Male

We describe the case of a 38-year-old man, with a 23-year history of anorexia nervosa, who developed severe osteoporosis which was discovered when he presented with a spontaneous crush fracture of his first lumbar vertebra. This case demonstrates the need to consider osteoporosis as a potential complication of chronic anorexia nervosa in male as well as female patients. © 1997 John Wiley & Sons, Ltd. and Eating Disorders Association.     

Case Report: A Rare Case of a Giant Right Coronary Artery Aneurysm

We report the case of a 34-year-old female patient with a giant thrombus-filled aneurysm of the right coronary artery presenting as a spherical cardiac mass on echocardiography. The cardiac mass was found to be an 8-cm right coronary artery aneurysm on cardiac magnetic resonance imaging, which also revealed a 3.5-cm proximal left coronary aneurysm and a very small aneurysm at the origin of the obtuse marginal coronary artery. Due to the extent and size of the right coronary aneurysm, a decision for surgical intervention was made. Resection of the right coronary artery aneurysm with vein graft replacement and a bypass to the left anterior descending followed by subsequent exclusion of the aneurysm was successfully performed.     

Treatment Optimization of Aortocoronary Dissection as a Complication After Heart Catheterization Using Coronary Computerized Tomographic Angiography

We present the case of a 71-year-old patient with a chronic total occlusion of the right coronary artery (RCA) resulting in a retrograde aortic dissection as a complication of coronary intervention. Acute therapy consisted of coronary stent implantation into the proximal RCA to cover the dissection's entry. One day after, computed tomography-guided angiography revealed a progression of the intramural aortic hematoma with a residual dissection at the RCA ostium. Recurrent coronary angiography was performed to implant another stent covering the entry. Imaging at follow-up demonstrated complete coverage of the Dunning dissection and regression of the intramural aortic hematoma.     

An Autopsy Case of Acute Pancreatitis Caused by Cholesterol Crystal Embolization

Cholesterol crystal embolization (CCE) shows a poor prognosis and it can cause ischemic organ damage due to a cholesterol embolism from atherosclerotic lesions in large blood vessels. Such an embolism mainly affects the kidneys and skin, although cases involving digestive organs have also been reported. We encountered an autopsy case of CCE with damage mainly to the digestive organs, including the pancreas. The patient had non-specific abdominal symptoms or image findings. Symptomatic therapy failed to save him. CCE can involve the digestive organs, and so must be differentiated from abdominal pathologies. Moreover, conventional treatments may be ineffective, and new treatments might thus be necessary.     

Significant Rectal Bleeding as a Complication of a Fecal Collecting Device: Report of a Case

We report the case of 65-year-old man who developed massive rectal bleeding associated with the use of a fecal collecting device: the Flexi-Seal Fecal Management System. A colonoscopy showed an acute laceration of the anterior rectal wall mucosa, 6 cm from the anal verge, with active bleeding. The tear was most likely the result of an acute event, such as sudden movement of the device within the rectum or trauma sustained during insertion. Massive transfusion was required, and surgical endoscopic treatment was necessary to ensure hemostasis. This is, to our knowledge, the first such case to be reported.     

Cholesterol pericarditis: Report of a case

Cholesterol pericarditis is an entity unknown in the English literature. Only a few cases have been reported, all of which appeared in the German literature. The following case is reported because of the rarity of this condition, the remarkable response to treatment, and the possibility that it represents an unusual myxedematous syndrome with an elevated basal metabolic rate.     

Comparison of Novel Equations for Estimating Low-Density Lipoprotein Cholesterol in Patients Undergoing Coronary Angiography

Aim: The importance of precisely quantifying low-density lipoprotein cholesterol (LDL-C) has become more pronounced over the years, with the rise of metabolic syndrome in the population and the reduction in LDL-C treatment goals. This study aims to compare two novel equations indirectly estimating LDL-C and assess their compatibility with Friedewald formula, in a population with high cardiovascular risk.Methods: This study is a retrospective analysis of the lipid profiles of 10,006 patients who underwent coronary angiography. LDL-C was calculated using Friedewald, Martin, and Sampson equations, and the compatibility between estimations was compared using methods of concordance and reclassification.Results: Our findings show that Martin and Sampson equations displayed high rates of upward LDL-C reclassification (10.8% and 7.5%, respectively) when compared with Friedewald equation. In comparison to the Sampson method, Martin also reclassified 3.8 % of patients to a higher LDL-C category. The magnitude of discordance between LDL-C estimates was more pronounced in hypertriglyceridemic patients, and this increased progressively with the reduction in LDL-C. The proportion of patients with LDL-C < 70 mg/dL reclassified to a higher LDL-C category reached 44% (Sampson vs. Friedewald), 65% (Martin vs. Friedewald), and 37% (Martin vs. Sampson) in those with triglyceride levels between 200 and 399 mg/dL.Conclusions: Both Martin and Sampson LDL-C estimates displayed significant proportion of upward discordance with reclassification to higher LDL-C categories compared to Friedewald formula, particularly in patients with elevated triglycerides and low LDL-C, a population in whom more accurate estimation of LDL-C is required. Further studies are warranted to validate the recently developed Sampson equation with comparison to Martin method that tended to more significantly overestimate LDL-C.     

Colonic Vascular Anomalies and Colon Cancer in Neurofibromatosis: Report of a Case

We report a case of neurofibromatosis with synchronous adenocarcinomas in the sigmoid and transverse colon. There was widespread intimal proliferation in arteries in the region of the tumors and also in the cecum. Such vascular lesions are associated with von Recklinghausen’s disease. The cecal lesion produced mural thickening visible on computed tomography. This case supports a possible genetic link between neurofibromatosis and adenocarcinoma of the colon.     

Possible Assessment of Coronary Plaque Morphology Before and After Treatment With Statin by Multislice Spiral Computed Tomographic Coronary Angiography—A Case Report

The case of a 58-year-old man with a previous anterior wall myocardial infarction and direct stenting who underwent multislice spiral computed tomographic (MSCT) coronary angiography with a row of 16 detectors before and after nine months of treatment with a statin is presented. MSCT coronary angiogram showed no significant stenosis in the left anterior descending (LAD) coronary artery, including the stented portion, and stress myocardial perfusion imaging showed that there was no ischemia. However, MSCT coronary images showed a lipid-rich plaque in the proximal portion of the stent implantation site in the LAD with a density of 17 Hounsfield units (HU) and with a size of 1.5 × 1.5 × 2.0 mm. MSCT coronary images obtained after nine months of treatment with pitavastatin showed that the plaque was smaller and had a density of 114 HU. MSCT coronary angiography allowed us to evaluate coronary artery plaque morphology before and after treatment with pitavastatin.