We report the case of a combined transcatheter strategy in an 83 year-old woman with severe aortic stenosis and right coronary artery stenosis. Due to morbid obesity, cardiac surgery was declined and a combined transcatheter procedure was performed: percutaneous coronary intervention, and transcatheter aortic valve implantation with a balloon-mounted stented valve (Edwards-Sapien, Edwards Lifesciences Inc.). The procedure was successfully completed and the patient was discharged 7 days later. To the best of our knowledge, this is the first case report of a simultaneous combined transcatheter approach with this type of valve and without circulatory assistance.
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A 57 year old diabetic male with a history of prior coronary artery bypass grafting 11 years ago was admitted with a troponinpositive acute coronary syndrome. He had undergone prior PCI to the vein graft to his RCA. Cardiac MRI and echocardiography suggested inferior wall viability. At angiography the RCA vein graft was found to be recently occluded and re-opened with adjunctive use of excimer laser atherectomy for extensive tissue debulking. Multiple drug eluting stents were then deployed and expansion maximised with intravascular ultrasound guidance. The practice of PCI on occluded vein grafts and of laser atherectomy is discussed.
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