Nasir Rahman

Myocardial Infarction in a Youngster Due to Giant Coronary Aneurysm

A 22‐year old male presented with acute inferior wall myocardial infarction. Coronary angiogram revealed normal left coronary arteries and a giant coronary aneurysm in Right coronary artery (RCA). Primary angioplasty of RCA was performed. Large thrombus burden was retrieved with aspiration device and coronary flow restored. However, despite best efforts some thrombus remained and decision to stent was deferred to a later date. Dimensions of aneurysm on quantitative coronary angiogram were 15 mm in width and 46 mm in length. Two weeks later coronary angiogram revealed normal flow in RCA without any angiographically visible thrombus. PCI was performed with two 3.0 × 28 mm Covered stents, Graft Master (JoStent) deployed across the aneurysm, overlapping each other. This completely sealed the aneurysm and intravascular ultrasound confirmed no leakage through the covered stents. Patient remains asymptomatic 2 months post procedure on triple antiplatelet therapy.

Trans-radial approach for coronary angiography in an adult postoperative patient with tetralogy of Fallot with complex anatomy

A 42-year-old, postoperative patient with tetralogy of Fallot (TOF) with right-sided aortic arch, presented with heart failure secondary to left ventricular dysfunction, severe valvular regurgitation and residual ventricular septal defect (VSD). After initial stabilisation, he underwent successful coronary angiography through a trans-radial approach followed by aortic valve replacement, pulmonary valve and VSD repair, and was discharged home in stable condition. This case report highlights the trans-radial approach as a feasible option for coronary angiography in postoperative patients with TOF with right-sided aortic arch.

A journey from CABG to drug-eluting balloon.

A middle aged male underwent series of percutaneous coronary intervention (PCI) of left main stenosis for Canadian cardiovascular society (CCS) IV angina. He developed recurrent severe proliferative in‐stent restenosis which was treated with different available options including drug‐eluting stents and finally with drug‐eluting balloons. During his treatment, challenges of PCI including left main chronic total occlusion PCI, complications like coronary perforation were encountered and treated successfully.

A journey from CABG to drug-eluting balloon: Recurrent ISR Successfully Treated with Drug-Eluting Balloon

A middle aged male underwent series of percutaneous coronary intervention (PCI) of left main stenosis for Canadian cardiovascular society (CCS) IV angina. He developed recurrent severe proliferative in‐stent restenosis which was treated with different available options including drug‐eluting stents and finally with drug‐eluting balloons. During his treatment, challenges of PCI including left main chronic total occlusion PCI, complications like coronary perforation were encountered and treated successfully.

A simpler approach to seal severe coronary perforation with bare metal stent

The case of a coronary artery perforation in which overinflation of a balloon at an angulated segment of the left anterior descending (LAD) artery after stent deployment resulted in an Ellis type III coronary artery perforation is presented. A bare metal stent (BMS) was used successfully to seal this high-grade perforation. Here, it is demonstrated that it may not be illogical to consider BMS as the first choice before embarking on use of a covered stent if the clinical/haemodynamic condition of the patient allows it and if a covered stent is not available.