Atul D. Abhyankar

Lack of evidence for improvement in internal mammary graft flow by occlusion of side branch

Coronary steal due to unligated side branches of an internal mammary artery graft has been reported previously. Embolization of these side branches has been shown to result in symptomatic improvement, but objective evidence of improved flow to the coronary artery has been lacking. We studied intracoronary Doppler flow in a patient presenting with symptoms thought to be due to a large unligated side branch of mammary graft. There was no significant change in the mammary flow after balloon occlusion of the side branch. More objective data may be required to routinely prescribe side branch embolization for symptomatic patients with unligated side branches of a mammary graft.

Delayed appearance of distal coronary perforation following stent implantation

Coronary perforations are usually apparent immediately after the occurrence. We report a case of a 67-year-old woman where coronary perforation presented 16 hours after the procedure. This case illustrates the need for extra vigilance and careful evaluation of distal vasculature while using stiff coronary guidewires.

Multiple coronary-pulmonary fistulae involving all three coronary arteries: a case report

Coronary pulmonary fistulae are rare cardiac anomalies. We present the case of a 46-year-old woman with multiple coronary-pulmonary fistulae involving all three coronary arteries. She presented with atypical chest pain and had no obstructive coronary lesion. SPECT thallium study demonstrated no perfusion defect. The fistulae were multiple but small with only a small left to right shunt (Qp:Qs = 1.2). The patient has remained well without intervention.

Angioplasty through a stent side door

Angioplasty was performed by entering a Gianturco-Roubin stent from the side through the coils of a previously-implanted hanging stent in an ostial lesion in a saphenous vein graft. No complications and no visible damage occurred to the stent. Although this method carries a possible risk of entrapment or damage to the stent, it is feasible when other options have failed.

Spontaneous regression of post-percutaneous transluminal coronary angioplasty aneurysm

We report a case of a 67-year-old male with spontaneous regression of post-percutaneous transluminal coronary angioplasty (PTCA) aneurysm. This case substantiates the benign prognosis of post-PTCA aneurysms.

Stent implantation in severely angulated lesions: Safety, efficacy, and morphological remodelling

Balloon angioplasty of severely angulated lesions is associated with a higher complication rate and lower success rate compared with non-angulated lesions. Whether this is true also of stenting such lesions is not know, nor has the alteration of vessel morphology produced by placing stents in these angulated segments been systematically investigated. We retrospectively analysed data from 60 patients who underwent stent implantation. Thirty patients formed a consecutive group whose stents were implanted in severely angulated lesions (> 45 degrees, group A). The other 30 were a a consecutive contemperaneous group whose stents were implanted in straight or less angulated lesions (group S). Change in morphology was assessed using a straightening index. In group A, 29 of the 30 patients had a successful angiographic and clinical outcome. In group S, 27 of the 30 patients had a successful outcome. Thus, unlike simple balloon angioplasty, stenting severely angulated lesions was not associated with a high-complication or low-success rate. Change in stented vessel morphology (straightening index) was greatest for right coronary (0.45 +/- 0.05), similar for left anterior descending (0.27 %/- 0.08) and circumflex (0.30 +/- 0.03), and least for vein grafts (0.14 +/- 0.10). The straightening index did not correlate with the preangioplasty lesion angulation, the maximum pressure used to inflate the stent, the size of the artery stented, or the type of stent used.

Rotational atherectomy of calcified ostial saphenous vein graft lesion with long term follow-up: a case report

Rotational atherectomy, though widely used for calcified and difficult lesions, has not been used in vein graft lesions. We performed rotational atherectomy on a 75-year-old male with a calcified ostial lesion in an 11-year-old vein graft. No complications were encountered and good result was obtained. Angiogram at 10 months revealed no restenosis.

Angioplasty and stenting in the presence of a thrombus using adjuvant abciximab (ReoPro)

Abstract Intracoronary thrombus has been associated with higher rates of ischaemic complications following percutaneous transluminal coronary angioplasty (PTCA). We used platelet glycoprotein IIb/IIIa integrin antagonist, abciximab (ReoPro), to treat 13 patients undergoing PTCA with angiographically detected thrombus. None of the patients developed new ischaemic complications. Two (15.4%) patients developed groin complications. Abciximab is an important new adjuvant therapy for PTCA and stenting associated with a thrombus.