Coronary artery perforation: a rare complication of coronary angiography.

We report perforation of two side branches of the right coronary artery during selective coronary angiography.We suppose that forceful injection of contrast into a non-dominant artery with severe proximal stenosis could have led to this complication.To the best of our knowledge this is the second reported case of coronary perforation during angiography.     

Perforation of a side branch of the right coronary artery during selective coronary angiography using 5 french judkins catheters

In this case report the first known case of a perforation of a side branch of the right coronary artery during diagnostic coronary angiography using 5 French Judkins catheters is described which occurred by selective intubation. Although catheter placement was controlled by contrast test injection the catheter occasionally intubated the conus artery superselectively just prior to the diagnostic injection. Thus, perforation of small side branches may be encountered especially by the use of 5 French Judkins catheters. © 1995 Wiley-Liss, Inc.     

Bailout polytetrafluoroethylene‐covered stent implantation for left main bifurcation perforation using the kissing stent technique

Coronary artery perforation during percutaneous coronary intervention is a rare, but potentially lethal complication. Immediate balloon expansion at the perforation site can halt the bleeding. Implantation of a coronary polytetrafluoroethylene (PTFE)‐covered stent enables the efficient endovascular repair of a coronary artery perforation. However, if the perforation occurs at a bifurcation, a PTFE‐covered stent may jail the side branch. We report a difficult case of blowout coronary perforation (Ellis type III) at a left main coronary artery bifurcation, which was successfully sealed with a PTFE‐covered stent without interference with the side branch coronary artery circulation. This new strategy might represent a useful salvage option for some patients with a coronary bifurcation perforation. © 2017 Wiley Periodicals, Inc.     

Left main perforation and acute stent thrombosis—a cath lab nightmare

Coronary perforation is a rare, but life‐threatening, complication that can develop during a percutaneous coronary intervention (PCI). Prompt nonsurgical treatment such as covered stent deployment can potentially arrest progression of the condition; however, other lethal complications such as acute stent thrombosis or side branch occlusion can occur. This report describes a case of perforation of the left main coronary artery that was successfully managed via stenting; however, acute stent thrombosis and side branch occlusion subsequently occurred under extracorporeal membrane oxygenation support. Means of avoiding this tragic outcome involve the routine use of intravascular ultrasound in patients undergoing PCI of the left main coronary artery, being respectful of circumferential calcification, and keeping the procedure as simple as possible. © 2011 Wiley‐Liss, Inc.     

64层螺旋CT血管成像与冠状动脉造影对冠心病诊断价值的对比研究

目的评价64层螺旋CT在冠状动脉造影方面的诊断价值。方法58例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,分别对左主干、左前降支、回旋支和右冠状动脉及其分支的重建图像行影像学评价,所有患者均行常规选择性冠状动脉造影检查作为对照。结果58例患者共757(87.0%)节段的冠状动脉(血管直径≥1.5 mm)成像,638节段(84.3%)可用于多层螺旋CT和冠状动脉造影定量分析。冠状动脉造影共发现狭窄101节段,多层螺旋CT发现狭窄104节段,多层螺旋CT对冠状动脉狭窄诊断的敏感性为86.1%,特异性为96.8%。结论64层螺旋CT冠状动脉造影可作为诊断冠状动脉病变的一种无创筛选方法。     

Covered stent implantation for the treatment of an aneurysm involving a coronary bifurcation

We report the percutaneous treatment of an aneurysm of the mid-segment of the left anterior descending artery involving a bifurcation with a diagonal branch in a patient with three-vessel disease. Due to the nonavailability of a dedicated device, we used a V-configured bifurcation system consisting of a polytetrafluoroethylene-covered stent for the main vessel and a baremetal stent for the side branch. The angiographic result was optimal and the patient remained symptom-free at 1-year follow up when the stress test was negative. The follow-up coronary angiography showed no restenosis of the coronary segments treated by stent implantation.     

Catheter-induced dissection of the left main coronary artery,the nemesis of an invasive cardiologist A case report and review of the literature

An elderly gentleman had a dissection of the left main coronary artery (LMCA) during coronary angiography. There were critical lesions in the left anterior descending (LAD) and left circumflex arteries. Both the LMCA and the LAD lesions were successfully stented in the same sitting. Thereafter the patient remained symptom free and the six-month follow-up angiogram revealed good angioplasty results in both lesions. We report this case for two reasons - first, acute dissection of the LMCA is a rare but devastating complication of selective coronary angiography and the situation becomes graver if the branch vessels have critical stenosis; that this could be managed percutaneously needs to be highlighted, and second, the case offers an opportunity to review literature pertinent to this awesome occurrence in the catheterization laboratory.     

Degenerative aortic valvular stenosis, coronary atherosclerosis, and coronary artery aneurysms: different anatomical manifestations of the same disease

We report a rare combination of valvular aortic stenosis, coronary atherosclerosis and numerous coronary artery aneurysms. A 80 year-old man with previously diagnosed aortic valvular stenosis was admitted to our department for coronary angiography before planned aortic valve replacement. Coronary angiography, apart from critical stenosis of proximal part of left anterior descendent branch of left coronary artery, revealed several large coronary artery aneurysms. We discuss the potential mechanisms responsible for coronary aneurysm formation.     

Complete proximal occlusion of all three main coronary arteries complicated with a left main coronary aneurysm: a case report

A 68-year-old woman with recurrent chest pain was referred to our institution. Coronary angiography showed 100% obstruction of the left main trunk, the proximal right coronary artery with good collaterals to the left anterior descending artery and left circumflex artery along the conus artery. Emergency surgical revascularization was undertaken with two saphenous vein grafts. The saphenous vein grafts were placed in the left anterior descending artery, obtuse marginal branch and the posterolateral and posterior descending coronary arteries with excellent flow. The postoperative course was uneventful and follow-up angiography was obtained 20 days after the surgery. Coronary angiography demonstrated a saccular aneurysm (10 x 9 mm) originating at the distal segment of the left main coronary artery with 90% stenosis, and excellent patency of both saphenous vein grafts. Follow-up angiography was performed 1 and 3 years after the surgery. The size of the left main coronary aneurysm remained unchanged at both examinations. The patient did well with no further cardiac symptoms after 5 years.     

Air embolism in the right coronary artery occurring during the left coronary angioplasty using the guiding catheter with a side hole.

Coronary air embolism is one of the inadvertent complications of coronary angioplasty. We report two rare cases of complicating air embolism in the right coronary artery occurring during control left coronary angiography using a guiding catheter with a side hole, just prior to a coronary intervention procedure for a left coronary artery lesion. The air seemed to be injected into the right coronary artery through the side hole. When we use an angiographic or guiding catheter with a side hole, we should be aware that an air embolism can occur in the contralateral coronary artery and should carefully and repeatedly perform aspiration of the catheter.     

Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: An interesting case report

Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1–2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase–MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication.     

Emergency stenting of unprotected left main coronary artery after acute catheter-induced occlusive dissection

Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.     

Coronarangiographic study on the trifurcation branch of the left coronary artery postmortem (author's transl)

In 141 human hearts by means of coronary angiography post mortem 72 (51.1%) were found with bifurcation and 63 (44.7%) with trifurcation of the left coronary artery. In 6 hearts there was a fourfold division of the left main coronary artery. The supplying areas of the trifurcation branch was located in the left anterior or lateral ventricular wall. Its size varied in a wide range. Partly it belonged to the supplying areas of the anterior descending, partly to the left circumflex branch.     

Progression of a small eccentric aneurysm to spontaneous coronary dissection within the left main coronary artery

A 67 year-old man presented with stable angina pectoris. He underwent primary angioplasty with stenting of the left anterior descending artery ostial lesion five months previously. A small eccentric aneurysm was shown within the left main coronary artery. A second angiography, performed a month later, showed slight enlargement of the aneurysm from the base side. In the final presentation, angiography revealed spontaneous dissection line beginning from the aneurysm base and extending to the left anterior descending artery. Although progression from coronary aneurysms to dissection is rare, it can occur, and patients monitored closely, especially when left main coronary aneurysm is present.     

Complete bundle branch block during exercise test. Clinical and coronary angiographic data

Thirty-two complete bundle branch blocks were observed during 16,500 exercise stress tests between 1973 and 1988: there were 7 right bundle branch blocks and 25 left bundle branch blocks. Exercise stress testing was indicated in 15 cases for stable angina, in 15 cases for different functional disturbances and in 2 cases as a systematic investigation. All patients underwent coronary angiography and selective left ventriculography. Right bundle branch block occurring at a heart rate of 105 +/- 25/mn were associated with typical anginal pain at the time of apparition in 5 patients. Coronary angiography showed triple vessel disease in 3 cases, double vessel disease in 2 cases and an isolated proximal lesion of the left anterior descending artery in 2 cases. Left bundle branch block occurring at a heart rate of 125 +/- 12/mn was associated with normal coronary angiography in 7 cases. Eighteen patients had pathological coronary angiogrammes with severe lesions of the left anterior descending artery. Two women suffered from chest pain when the block developed and coronary angiography was normal in one of them. During follow-up (average 62 months), 16 coronary events were observed including 2 infarcts, and 6 patients developed cardiac failure. In conclusion, complete right bundle branch block appearing during exercise stress testing was constantly associated with atherosclerotic coronary artery disease. The predictive value of complete left bundle branch block on effort was 72%. Complete left bundle branch block occurring at heart rates of less than 120/mn was frequently associated with a proximal stenosis of the left anterior descending artery.     

Hypoplastic left coronary artery. In association with occlusive intimal thickening of a coronary artery with ectopic ostium and with atresia of the left coronary ostium

Two cases of hypoplastic coronary artery (HCA) are presented. Case 1, a 13 year old girl, died suddenly during a long distance race. She had HLCA with marked intimal thickening and an ectopic left coronary ostium above the commisure between the non-coronary and left coronary cusp at post mortem examination. The right coronary artery (RCA) was enlarged and also supplied parts of the area normally supplied by the left coronary artery (LCA). Pathological findings revealed a normal RCA and an extremely hypoplastic LCA with occlusive proliferation of the intima and a myocardial infarction of the left ventricle. Case 2, a 6 year old girl, had a history of effort angina. Selective coronary angiography was performed which failed to demonstrate the orifice of the LCA by aortography. However, the hypoplastic LCA was visualized by RCA angiography as a consequence of anomalous collaterals from the atrioventricular branch of the RCA. We postulate that HCA results from various conditions, including stenosis of the coronary artery orifice, an aberrant course between the pulmonary artery and aorta and ectopic positioning of the coronary artery ostium. In addition, HCA may also be associated with occlusive coronary artery abnormalities.     

Complications of emergency coronary angioplasty for acute myocardial infarction]

To assess the incidence and consequences of complications occurring during emergency percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI), we studied 347 patients who underwent PTCA within 24 hours after the onset of AMI. Acute occlusion occurred in 29 patients (8.4%), of whom 16 patients underwent successful repeat PTCA. All of them survived until hospital discharge. The in-hospital reocclusion rates of these 16 patients were comparable to those of patients who had not experienced acute occlusion (18.8 vs 12.8%, ns). In the remaining 13 patients, reperfusion were not successful after acute occlusion, and 6 died. Side branch occlusion occurred in 21 patients (6.1%). Left circumflex artery occlusion occurring during PTCA for the proximal left anterior descending artery was fatal in 3 patients. Right ventricular branch occlusion during PTCA for the middle of the right coronary artery resulted in intractable right ventricular infarction in one patient, and he died. Among 14 patients who underwent repeat angiography, 13 had a patent side branch which had been occluded during PTCA. One patient had coronary rupture and died. During PTCA of the proximal left anterior descending artery, acute occlusion of the artery without reperfusion or occlusion of the left circumflex artery was often fatal. However, the prognosis of acute occlusion was relatively good, if repeat PTCA was successful and most of the occluded side branches remained patent in the chronic state.     

Collateralization of an occluded left internal mammary artery coronary bypass graft

The left internal mammary artery (LIMA) is frequently utilized in coronary artery bypass grafting (CABG); adequate visualization of the LIMA bypass graft during diagnostic angiography is critical for determination of myocardial blood supply. We present a novel case of angiography via a left transradial approach demonstrating an occluded LIMA coronary bypass graft with antegrade flow maintained via a collateral branch from the ipsilateral thyrocervical trunk. Given the prevalence of LIMA use in CABG, it is critical to be aware of unusual configurations, including collateralization of a proximally occluded LIMA graft as described in this report.     

Novel stent and delivery systems for the treatment of bifurcation lesions: porcine coronary artery model.

BACKGROUND: In percutaneous treatment of bifurcation coronary lesions, side-branch restenosis remains a significant limitation in current therapeutic approaches. Coronary stents with a side aperture and a sleeve may be clinically advantageous to maintain access to side branch, stabilize the side-branch orifice, and deliver the appropriate drug to the side-branch ostium. METHODS: A novel stent system (PETAL stent; Advanced Stent Technologies, Pleasanton, CA), incorporating a side aperture with deployable struts, was compared within porcine coronary model to the prior stent version having only the side aperture (SLK-View stent). In six pigs, each stent was implanted either in the left anterior descending coronary artery or the left circumflex coronary artery with adjunctive kissing balloon dilatation. At 28-day follow-up, coronary angiography was performed. RESULT: A total of six SLK-View stents and six PETAL stents were implanted in coronary arteries without any complication, and adjunctive kissing balloon dilatations were successful in all lesions. Quantitative coronary angiography (QCA) data at 28 days showed that PETAL stents exhibited superior QCA in mean diameter compared with SLK-View stents for side branch, inferring efficacy of PETAL ostial struts. CONCLUSION: AST-PETAL stent has the potential to be a new solution for treatment of bifurcation lesions. Antirestenosis drug elution should be considered with this successful platform.     

Angiographic detection of the left anterior descending and the right coronary artery after fistulas into the pulmonary artery in a patient with rheumatic mitral stenosis

Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography.