Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

The addition of femoral-femoral cardiopulmonary bypass in the cardiac catheterization laboratory to support the high risk patient is a challenging new frontier for percutaneous transluminal coronary angioplasty. We report our first experience of successful supported angioplasty in patient presented with exertional angina and orthopnea who had multi-vessel coronary artery disease with depressed left ventricular ejection fraction. Although cardiopulmonary support provides excellent support for high-risk patient, CPS is a technically challenging and expensive procedure associated with significant patient morbidity or complication. Despite its drawbacks, CPS has been shown to help save the lives of selected patients undergoing high-risk procedures.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Coronary Artery Disease ; Humans ; Stroke Volume

Percutaneous transluminal coronary angioplasty (PTCA) is often used in the management of coronary artery disease and the advances in equipment, technichal skill and acquisition of operator experiences have improved initial success rates and reduced the frequency of complications. However, acute coronary occlusion is the most common and serious complication related to angioplasty and its several potential mechanisms are intracoronary thrombus, coronary artery spasm and coronary artery dissection. Accordingly,heparinization, intracoronary thrombolysis, re-PTCA, stent implantation and emergency coronary artery bypass grafting have been previously used for reopening of an occluded coronary artery during angioplasty. In this report we describe our experience in the management of acute coronary occlusion of left anterior descending artery caused by dislodgement of thrombotic material during PTCA by means of aspiration thromboembolectomy instead of medical therapy,re-PTCA and stent implantation.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Occlusion* ; Coronary Vessels ; Emergencies ; Spasm ; Stents ; Thrombosis

Percutaneous transluminal coronary angioplasty of chronic total coronary artery occlusions are at a high risk of failure and complication. We report a case of arteriovenous fistula with drainage into the coronary sinus during the percutaneous transluminal coronary angioplasty of the chronic total occlusion of circumflex coronary artery. We think that the arteriovenous fistula of this case was occurred by the guide wire- induced trauma. But after 20-30 minutes later, the injection of contrast no longer detectd arteriovenous fistula. Later we recommended coronary artery bypass graft surgery to the patient, but he refused. Thereafter he received conservative treatment and dyspnea, chest pain were improved.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteriovenous Fistula* ; Chest Pain ; Coronary Artery Bypass ; Coronary Sinus* ; Coronary Vessels* ; Drainage* ; Dyspnea ; Humans ; Transplants

BACKGROUND AND PURPOSE: Abrupt vessel closure and acute ischemia were unpredictable during percutaneous transluminal coronary angioplasty. Abupt or threatened closure after coronary angioplasty is associated with increased risk of myocardial infarction, emergency coronary artery bypass graft surgery and in-hospital mortality. One of major causes of these complications was associated with coronary artery dissection. Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. This study reports on the early clinical experience with flexible coil stent in a single center. METHOD: From March 1993 through December 1993, 33 patients underwent coronary stenting with flexible coil stent(12-20mm length, 2.5-3.5mm diameter) for various indications(acute or threatened closure, suboptimal result after balloon angioplasty, elective). RESULTS: Thirty-two flexible coil stent were successfully deployed in 31 patients among 34 attempted stents with 94% of procedural success rate. Intracoronary stenting resulted in an immediate angiographic improvement in the diameter stenosis from 87% before stenting to 18% after stenting by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 of 33 patients(3%). The incidence of in-hospital myocardial infarction(Q wave and non-Q wave) was 3% (1 of 33 patients.) Complications included blood loss, primarily from the arterial access site in 4 patients, hemopericardium and aspiration pneumonia in 1 patients respectively. CONCLUSION: Initial experience with flexible coil(Gianturco-Roubin) coronary stent indicates that it is a useful adjunct percutaneous intervention to prevent or minimize complications associated with coronary artery dissection after balloon angioplasty with high technical success rate.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Vessels ; Emergencies ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction ; Pericardial Effusion ; Pneumonia, Aspiration ; Stents* ; Transplants

Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; therapy ; Guideline Adherence ; Humans ; Practice Guidelines as Topic

The widely accepted method for coronary artery bypass grafting(CABG) is performing the distal coronary artery anastomoses on the flaccid and nonbeating heart with the aid of cardiopulmonary bypass(CPB) and cardioplegic arrest. However, current cardioplegic techniques are not consistent in avoiding myocardial ischemic damages especially in high risk patients undergoing CABG. In this regard, "Off-Pump" seems to be an ideal method for preventing myocardial ischemic damage and adverse effects during CPB. However, "Off-pump" CABG is not always technically feasible. We report 2 cases of "On-pump" CABG performed on the beating heart in high risk patients; The first patient had left ventricular dysfunction(Ejection Fraction=25%), and the second patient had cardiogenic shock after percutaneous transluminal coronary angioplasty.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Vessels ; Heart* ; Humans ; Shock, Cardiogenic

Angioplasty, Balloon, Coronary ; methods ; Coronary Artery Bypass ; methods ; Coronary Vessels ; surgery ; Humans

Management of Takayasu's arteritis of the left main coronary artery (LMCA) is difficult because of the possibility of restenosis. Clinically significant stenotic lesions must be considered anatomical correlation. Many studies have reported that the management of stenotic lesions of the LMCA with endoluminal stenting and balloon angioplasty and de-novo stenting is safe and effective for patients with Takayasu's arteritis. We report the case of a patient with Takayasu's arteritis of the LMCA. The patient had undergone two consecutive percutaneous coronary interventions because of recurrent restenosis of in-stent lesions, and eventually underwent coronary artery bypass graft (CABG) surgery for myocardial infarction in the same lesion. We suggested treatment with CABG because the pathophysiology of Takayasu's arteritis is different from that of atherosclerotic stenosis.
Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents ; Takayasu Arteritis ; Transplants

BACKGROUND: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. MATERIAL AND METHOD: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was 63.7+/-8.9 (46~80) years, with 14 male patients (51.9%). RESULT: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was 53.6+/-63.4 months. CONCLUSION: Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass* ; Coronary Vessels* ; Emergencies* ; Follow-Up Studies ; Humans ; Male ; Mortality ; Rupture ; Shock