Very late stent thrombosis, defined as a thrombotic occlusion of a stent greater than one year after its implantation, occurs rarely but is associated with high mortality. Multiple mechanisms that contribute to stent malapposition, inappropriate endothelialisation, or incomplete platelet inhibition have been postulated to precipitate this phenomenon. Diabetes, acute coronary syndrome, and age have been suggested to increase the risk of stent thrombosis in large scale trials. To date, very late stent thrombosis has been thought to solely involve drug-eluting stents, however it may occur in 0.3% to 0.5% of a highly selected population. However, we describe a case of very late stent thrombosis (VLST) presenting seven years after the implantation of a bare metal stent.
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A coronary artery fistula connects a coronary artery to a heart chamber or a segment of the systemic or pulmonary system. Most of the fistulas are asymptomatic, but some can be associated with serious outcomes. Surgical intervention has been the treatment of choice but percutaneous technique has been considered as a safer alternative for certain cases of CAF. The fistula connects a giant and tortuous Circumflex coronary artery to the right atrium. We report a case of percutaneous CAF closure using an Amplatzer duct occluder device. Closure of the fistula was successful without any complications.
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Primary percutaneous coronary intervention is a situation that can benefit from the advantages of magnetic navigation. This case describes the use of this novel system to rapidly perform a complex primary PCI. Magnetic navigation has distinct advantages including the guidance of wire orientation on 3D information such as preset vectors, precise deflection that obviates the need for wire rotation. In addition magnet navigation offers the possibility to reconstruct a tailored 3D model that can be used to facilitate complex procedures.
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A 56 year-old man was admitted to the primary hospital with non-ST-elevation myocardial infarction. After four days without recurrence of chest pain, he was transferred to the regional hospital for a coronary angiography. Before planned catheterisation a ventricular fibrillation occurred. Under resuscitation conditions, a coronary angiography was performed and a thrombotic occlusion of the left main coronary artery was discovered. The thrombus was removed via a guiding catheter. Heart function immediately normalised. Haematologic tests proved a thrombophilic state. During echocardiography a patent foramen ovale was found. We continued with long-term medication acetylsalicylic acid + coumadin.
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While treating a subacute in-stent thrombosis, a stent implanted seven days earlier in a 47 years old man with acute coronary syndrome was unexpectedly extracted out by an extraction catheter.
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Cardiac free wall rupture is a well recognised complication of acute myocardial infarction, but despite this its angiographic features are poorly described in the literature. This is an interesting case of acute free wall rupture masquerading as a distal wire perforation. It highlights the importance of suspecting left ventricular wall rupture in the context of primary angioplasty, if any “arterio-venous malformations” or small vessel leaks are apparent, particularly if they are multiple and in adjacent territories.
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