Unusual Interventional Treatment Of Spontaneous Coronary Artery Dissection Without Stent Implantation: A Case Series

Background Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after cutting balloon angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after cutting balloon angioplasty. Case summary Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with cutting balloon angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by cutting balloon angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy. Conclusion Cutting balloon angioplasty may be a possible method to treat SCAD.

Intrastent hematoma after treatment with a drug eluting balloon for in-stent restenosis: a case report

Back ground Intrastent hematoma after dilatation of in-stent restenosis is rarely reported and the optimal treatment for this condition remains unclear. Case summary We present the case of an 87-year-old man with in-stent subtotal occlusion of left circumflex (LCX). He experienced chest pain after drug eluting balloon (DEB) was released in the stent. Intravascular ultrasound (IVUS) revealed intrastent hematoma, which was not relieved with a cutting balloon but completely sealed by an Endeavor Resolute stent. Discussion Intrastent hematoma after dilatation of in-stent restenosis is rare. Reimplantation of stent seems the best method to solve this problem. IVUS imaging may provide insight into the cause of in-stent restenosis and guide the treatment.

Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection

We present a case of successful revascularization for spontaneous coronary artery dissection (SCAD) using coronary artery fenestration followed by the subintimal transcatheter withdrawal (STRAW) technique. The combination of the STRAW technique and coronary artery fenestration with cutting balloon angioplasty could be a new treatment option for SCAD patients requiring revascularization.

Carotid In-Stent Stenosis: Cutting Balloon Angioplasty: 2-Dimensional Operative Video

In-stent stenosis has a reported prevalence of 14% to 19% at 1-yr follow-up after carotid stenting and is associated with an increased risk of acute ischemic stroke.1,2 Risk factors include female sex, diabetes, and dyslipidemia. Cutting balloon angioplasty is a safe and effective treatment modality for the treatment of carotid in-stent stenosis, and alternative treatment options include observation with medical management and placement of another stent.3,4 The authors present the case of a 61-yr-old man with carotid in-stent restenosis and progressive worsening on serial imaging with ultrasound. The patient had a history of carotid stenting for symptomatic stenosis 6 mo prior and was maintained on aspirin and clopidogrel. In light of the progressive worsening, the in-stent stenosis was confirmed on computed tomography (CT) angiogram. The options were discussed with the patient and he consented for treatment with cutting balloon angioplasty. Final angiogram showed improvement of the luminal diameter with a residual stenosis of 15%. The patient tolerated the procedure well and was discharged home on postoperative day 1. Follow-up ultrasound demonstrated moderate improvement in peak systolic velocities, and the plan is to continue observation with a clinical follow-up and repeat carotid Dopplers at 3 mo.