scholarly journals Iatrogenic acute aortic dissection caused by intervention for spontaneous coronary artery dissection: a surgical case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuki Hayashi ◽  
Makoto Taoka ◽  
Shunji Osaka ◽  
Satoshi Unosawa ◽  
Masashi Tanaka
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Type A ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Percutaneous Coronary

Abstract Background Iatrogenic acute aortic dissection (AAD) caused by cardiovascular intervention is rare. Also rare is spontaneous coronary artery dissection (SCAD), a form of acute coronary syndrome, which develops in relatively young women without coronary risk factors. We encountered type A iatrogenic AAD caused by an intervention for SCAD. Case presentation A 53-year-old woman was brought to our hospital after cardiopulmonary resuscitation. She was diagnosed with acute coronary syndrome caused by SCAD, and percutaneous coronary intervention was carried out on her distal left anterior descending artery. The dissection proceeded to the proximal left anterior descending artery and left main coronary artery trunk, so additional percutaneous coronary intervention was performed on the left circumflex artery. After the intervention, type A AAD occurred with a primary entry tear from the left main coronary artery trunk, and computed tomography showed a type A AAD of the aortic arch. We performed emergency ascending aorta replacement and coronary artery bypass grafting to the left anterior descending artery and left circumflex artery. The patient had an uneventful recovery after the operation and was discharged on postoperative day 25. Conclusion To our knowledge, this is the first report of an iatrogenic AAD caused by percutaneous coronary intervention for SCAD.

scholarly journals Features of coronary artery patterns and percutaneous coronary intervention in patients with acute coronary syndrome and stable angina in patients aged below 40 years

2020 ◽  
Vol 101 (1) ◽  
pp. 18-24 ◽  
Author(s):  
F Z Abdullaev ◽  
N M Babaev ◽  
L S Shikhieva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim. To study the features of risk profile, coronary artery patterns, and percutaneous coronary intervention in patients aged below 40 years with acute coronary syndrome and stable angina. Methods. 208 patients with coronary artery disease aged below 40 years were examined: 51 (24.5%) patients aged 35 years and younger and 157 (75.5%) aged 3640 years. 98 (47.1%) patients were admitted with acute coronary syndrome; 110 (52.9%) patients with stable angina. In groups of acute coronary syndrome and stable angina, myocardial infarction in past medical history was revealed in 23.5% and 36.4%, respectively. 165 patients underwent percutaneous coronary intervention: 84 (50.9%) with acute coronary syndrome; 81 (40.1%) with stable angina. Results. Patients with stable angina differed by prevalence of myocardial infarction in past medical history, overweight, and family history of coronary artery disease. In group of acute coronary syndrome urban cohort prevailed as well as consumption of energy drinks among patients below 35 years; high prevalence of left ventricular dysfunction. Patients with acute coronary syndrome were characterized by involvement of one and three coronary arteries, and patients with stable angina by pathology of two and three coronary arteries. Involvement of three coronary arteries was equal in both groups. In both groups, anterior interventricular artery was target coronary artery. Patients with stable angina had the same rate of right coronary artery and left circumflex artery involvement. In patients with stable angina, right coronary artery involvement was rarer, and left main coronary artery involvement was two times more frequent than in patients with acute coronary syndrome. The group with acute coronary syndrome was characterized by predominance of discrete lesions and coronary occlusions over diffuse lesions; and the group of stable angina by diffuse lesions, and two-times less frequent coronary occlusions. Conclusion. Among patients with acute coronary syndrome aged below 36 years, revascularization of right coronary artery was predominant, and among patients aged 3640 years with acute coronary syndrome revascularization of left circumflex artery.

scholarly journals Bioabsorbable Vascular Scaffolds Eluting with Everolimus: for Percutaneous Coronary Intervention of Patients with de-novo Coronary Artery Lesion: Our Experiences at a Tertiary Hospital

2014 ◽  
Vol 6 (2) ◽  
pp. 122-126
Author(s):  
AHMW Islam ◽  
S Munwar ◽  
S Talukder ◽  
AQM Reza ◽  
T Ahmed ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
De Novo ◽  
Positive Family History ◽  
Coronary Intervention ◽  
Coronary Artery Lesion ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Percutaneous Coronary ◽  
Vascular Scaffold

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention (PCI) of de-novo coronary artery lesion by using Bioabsorbable Vascular Scaffold (BVS) ABSORB stents eluting Everolimus. Methods: Total 16 patients were enrolled in this very preliminary study of BVS absorb. Among them, Male: 11 and Female: 5. Total 20 stents were deployed. Mean age were for Male: 56 yrs, for Female: 60 yrs. Associated coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history (FH) for CAD and Smoking. Patients were followed up clinically. Results: Among the study group; 13 (81%) were Dyslipidemic, 10(62.5%) were hypertensive; 6 (37.5%) patients were Diabetic, FH 3(18.75%), and 2(18%) were all male smoker. Female patients were more obese [Body Mass Index (BMI) M 25: F 27] and developed CAD in advance age. A common stented territory was for left anterior descending artery (LAD): 6 (37.5%), left circumflex artery (LCX) 5 (25%), right coronary artery (RCA) 6(37.5%). One patient had both LCX and LAD stenting. Total 3 patients had double/overlapping stent in RCA lesion. Territory wise distributions of BVS ABSORB stent were for LAD 6(30%), RCA 9 (45%), and LCX 5 (25%). There was no periprocedural or postprocedural complication. Conclusion: BVS ABSORB Everolimus eluting vascular scaffold showed favorable clinical outcome without any major cardiac events (acute or late stent thrombosis, MI or death) over a period of 9 month. Thus, BVS ABSORB would be favorable alternative to other available drug eluting metallic stents. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18352 Cardiovasc. j. 2014; 6(2): 122-126

scholarly journals Comparable Periprocedural Outcomes of Percutaneous Coronary Intervention in Male and Female Patients with Type C Lesions

2017 ◽  
Vol 02 (03) ◽  
pp. 021-024
Author(s):  
Narapureddy Reddy ◽  
Nemani Lalita
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Success Rate ◽  
Coronary Intervention ◽  
Circumflex Artery ◽  
Serum Triglycerides ◽  
Left Circumflex Artery ◽  
Percutaneous Coronary ◽  
Type C ◽  
Male Patients

Background Percutaneous coronary intervention (PCI) in type C lesions has low success and has high procedural risk. We aimed at studying the outcomes of PCI in patients with type C lesions. Material and Methods Total 180 patients with type C lesions who underwent PCI from January 2007 to December 2014 were taken into study and analyzed. Results Of 180 patients, 141(78.3%) were males and 39 (21.7%) were females. Mean hemoglobin concentration, mean serum triglycerides, and mean estimated glomerular filtration rate were significantly lower in females compared with males. Seventy-seven (42.8%) patients had lesions in right coronary artery, 67 (37.2%) had lesions in left anterior descending coronary artery, 31 (17.2%) had lesions in left circumflex artery, and 5 (2.8%) had left main coronary artery disease. Complex lesions were common in males. Chronic total occlusion (CTO) was found in 140 cases and other than CTO of type C lesions in 40 patients. Predilatation was done in 169 (93.9%) patients. Successful PCI was done in 157 (87.2%) patients. Lesion could not be crossed in 11 (6.1%) patients. Only plain old balloon angioplasty could be done in 9 (5%) patients. Other complications occurred in 3 (1.67%) patients. There was no difference between female and male patients in requiring predilatation or crossing the lesion or in not being able to deliver the stent. Conclusion PCI success rate among patients with type C lesions was 87.2% with low-complication rate in the present era. There was no difference in between female and male patients in success rate or complications.

scholarly journals A case report of successful complex percutaneous coronary intervention for acute coronary syndrome in a paediatric patient with familial hypercholesterolaemia

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Mrunmayee Deshpande ◽  
Milind Phadke ◽  
Talha Khan Abid ◽  
Ajay U Mahajan
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Left Main ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Symptomatic Coronary Artery Disease ◽  
Artery Disease

Abstract Background Familial hypercholesterolaemia (FH) is a primary genetic dyslipidaemia characterized by elevation in serum low-density lipoprotein cholesterol and its deposition in systemic arteries, which causes premature atherosclerosis. Case summary A 10-year-old girl presented with severe symptomatic coronary artery disease. She demonstrated characteristic morphological features of FH. Despite aggressive medical management and lipid-lowering therapy, her symptoms were not relieved and she had dynamic electrocardiogram changes. Coronary angiography showed a distal left main coronary artery lesion along with significant lesions in ostio-proximal and mid-left circumflex artery which were managed by provisional left main coronary artery to left circumflex artery stenting technique, with good immediate- and short-term results and angina relief. Discussion To the best of our knowledge, this is the first reported case of a paediatric patient with FH and acute coronary syndrome treated with percutaneous coronary intervention to left main coronary artery and left circumflex artery using provisional stenting technique. Revascularization strategies for symptomatic coronary artery disease in paediatric patients with FH have multiple unique challenges and remain an unexplored and under-reported subject.

scholarly journals Successful Percutaneous Coronary Intervention Using Intravascular Ultrasound-Guided Rewiring Technique in a Case of Spontaneous Coronary Artery Dissection Involving Left Main Bifurcation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yohei Numasawa ◽  
Souichi Yokokura ◽  
Yasuhiro Hitomi ◽  
Shohei Imaeda ◽  
Makoto Tanaka ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Guide Wire ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
True Lumen ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Percutaneous Coronary ◽  
St Elevation

We herein describe a 49-year-old woman without significant cardiovascular risk factors who was transferred to our hospital with sudden onset of chest pain. The patient was diagnosed with non-ST-elevation acute myocardial infarction, and coronary angiography revealed a dissection at the proximal site of the left anterior descending artery (LAD) extending from the left main trunk (LMT) suggestive of spontaneous coronary artery dissection (SCAD). Because coronary flow was impaired after contrast injection and the patient had chest pain with ST elevation, urgent percutaneous coronary intervention was performed. The first guide wire was initially introduced from the LMT to the distal LAD, but intravascular ultrasound (IVUS) imaging revealed that the guide wire had passed through the true lumen of the left coronary artery ostium, false lumen at the ostium of the left circumflex artery, and true lumen of the distal LAD. We then reinserted another guide wire using an IVUS-guided rewiring technique from the true lumen of the LMT to the distal LAD. Finally, a drug-eluting stent was deployed to cover the dissected segment, and final coronary angiography revealed acceptable results with a patent left circumflex artery. This case report highlights that physicians should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in young women. In the present case, IVUS played a pivotal role in not only detecting the arterial dissection but also correctly introducing the guide wire into the true lumen.

scholarly journals А САSЕ OF SPONTANEOUS CORONARY ARTERY DISSECTION (REVIEW AND CASE REPORT)

2019 ◽  
Vol 9 (1) ◽  
pp. 23-30
Author(s):  
N. T. Vatutin ◽  
G. G. Taradin ◽  
D. V. Bort ◽  
A. V. Dmitriev ◽  
I. V. Kanisheva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Clinical Manifestations ◽  
Intramural Hematoma ◽  
Coronary Intervention ◽  
Stress Factors ◽  
Artery Dissection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The article presents a literature review on the problem of spontaneous dissection of the coronary artery (SCAD) — tearing of its wall, not associated with atherosclerosis, trauma or iatrogenic effects leading to blood penetration between vessel layers of the artery. The consequence of this dissection is obstruction of the coronary artery due to the formation of intramural hematoma or intima damage, and myocardial ischemia with development of acute coronary syndrome, myocardial infarction or sudden cardiac death. Information on the epidemiology, pathophysiology andetiology of the disease is presented here. It was highlighted a role of arteriopathies, inflammatory diseases, pregnancy and female sex hormones, genetic causes as well as initiating and stress factors in its development. The clinic picture and diagnosis of the disease is described. It was emphasized that in addition to clinical manifestations, the traditional electrocardiogram and coronary angiography remain the standard for diagnostics of the dissection. In the treatment of SCAD, percutaneous coronary intervention with stenting of the affected artery is used, coronary artery bypass surgery and medications with regard to preference of conservative drug therapy. A special attention is paid to the features of diagnostic and therapeutic measures in pregnant and breast-feeding patients. The article also presents a clinical case of development of large-focal myocardial infarction complicated by cardiogenic shock in a young woman without risk factors for coronary heart disease in the postpartum period caused by SCAD. Diagnosis of the disease was accompanied by certain difficulties. An urgent percutaneous coronary intervention with stenting of the infarct-related coronary artery allowed rapidlyimproving and stabilizing the patient’s condition.

Sign in / Sign up

Export Citation Format

Share Document