Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.
Angioplasty, Balloon, Coronary ; Aorta ; Atherectomy, Coronary ; Catheters ; Coronary Vessels ; Percutaneous Coronary Intervention ; SNARE Proteins ; Stents

BACKGROUND: Balloon PTCA for the distal, long, eccentric coronary artery stenosis will be at high risk for severe dissection or acute occlusion during or after procedure. METHODS AND RESULTS: High Speed Rotational Atherectomy followd by low pressure balloon angioplasty due to distal, long, eccentric coronary artery stenosis. Rotational coronary atherectomy debulked the lesion quickly without difficulty. Rotational Coronary Atherectomy with adjuctive low pressure balloon inflation was successful without event. CONCLUSIONS: This case illustrates the point that complementary deployment of devices may not only improve success of percutaneous coronary intervention, but also may extend its scope.
Angioplasty, Balloon ; Atherectomy, Coronary* ; Coronary Stenosis ; Inflation, Economic ; Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Since 1987, coronary stents have changed the pattern of practice of interventional cardiology, by reducing the complications and improving the clinical outcomes. However, coronary stent restenosis still remains a significant clinical problem in the field of interventional cardiology. The aim of this trial was to compare the clinical efficacy of a rotational atherectomy (ROTA), with that of a plain old balloon angioplasty (POBA), in patients with coronary stent restenosis. SUBJECTS AND METHODS: One hundred and three patients (men 80, 58.4+/-10.3 years of age), diagnosed with coronary stent restenosis, at Chonnam National University Hospital, between January 1999 and December 2000, were analyzed. The clinical end-points were the occurrence of major adverse cardiac events (MACE): death, myocardial infarction and target lesion revascularization (TLR) during the one-year clinical follow-up. RESULTS: The baseline clinical and angiographic characteristics were similar between the two groups. Before the percutaneous coronary intervention (PCI), the diameter of stenosis of the POBA and ROTA groups were 81.9+/-14.0 and 82.9+/-10.0%, respectively, which decreased to 25.5+/-15 and 22.7+/-12% after treatment. At the one-year clinical follow-up, the TLR rates were 7.0 and 6.3% in the POBA and ROTA groups, respectively. The MACE results were not different between the two groups (7.0 and 9.4% in the POBA and ROTA groups, respectively). CONCLUSION: There was no significant long-term clinical benefit of a rotational atherectomy prior to a POBA, compared with a POBA alone, for the treatment of coronary stent restenosis.
Angioplasty ; Angioplasty, Balloon* ; Atherectomy, Coronary* ; Cardiology ; Constriction, Pathologic ; Follow-Up Studies* ; Humans ; Jeollanam-do ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents*

Background: Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. Methods: From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis. Results: The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P < 0.001). The final lumen diameter was also larger in the RA+CB group compared to that in the RA group (2.81 ± 0.41 mm vs. 2.60 ± 0.25 mm, t = 2.111, P = 0.039). Moreover, patients receiving RA and CB tended to have larger final lumen gain (2.15 ± 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132). Multivariate Cox regression analysis indicated that the strategy of RA+CB was a significant protective factor against long-term (>1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043). Conclusions In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
Aged ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Male ; Percutaneous Coronary Intervention ; Stents ; Treatment Outcome

Angioplasty, Balloon, Coronary ; Humans ; Percutaneous Coronary Intervention ; methods ; Tungsten

Angioplasty, Balloon, Coronary ; Humans ; Percutaneous Coronary Intervention ; instrumentation

OBJECTIVETo explore the clinical values of ST-segment changes in ST-segment elevated myocardial infarction (STEMI) patients within 24 hours after primary percutaneous coronary intervention (PCI).

METHODSA total of 225 patients with STEMI underwent primary PCI were enrolled, the ST segment resolution 1 hour after PCI was calculated and the patients were divided into group A (n = 135, Sgr;STE resolved ≥ 50%) and group B (n = 90, Sgr;STE resolved < 50%). The patients in group B were further divided into group C (n = 56, Sgr;STE resolved ≥ 50%) and group D (n = 34, Sgr;STE resolved < 50%) according to the ST segment resolution at 24 hours after PCI. TIMI flow after PCI, in-hospital major adverse cardiac events (MACE) and cardiac function about 7 days post PCI were analyzed.

RESULTSData between group A and group B were similar except the incidence of pre-PCI Killip ≥ II was significantly higher in group B than in group A (37.8% (34/90) vs. 17.0% (23/135), P < 0.05). Incidence of complicated diabetes (P < 0.05), pre-PCI Killip ≥ II (55.9% (19/34) vs. 26.8% (15/56), P < 0.05) and multivessel disease (70.6% (24/34) vs. 35.7% (20/56), P < 0.05) were significantly higher in group D than in group C. TIMI 3 and the opening time of IRA was similar between group A and group B and between group C and group D. The incidence of in-hospital MACE was significantly higher in group B than in group A (14.4% (13/90) vs. 3.0% (4/135), P < 0.05) which was similar between group C and group D.

CONCLUSIONEarly (1 hour) but not late (24 hours) ST resolution post PCI is related to a favorable clinical outcome in STEMI patients.

The incidence of coronary artery disease requiring coronary intervention in patients with Kawasaki disease is high. Because coronary artery lesions in Kawasaki disease commonly involve severe calcification and aneurysmal changes which can progress with time, in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly applied. However, the experience of coronary intervention in Kawasaki disease is extremely limited compared to that with intervention in adults, which provides satisfactory therapeutic results. There are several kinds of percutaneous coronary intervention techniques in Kawasaki disease including balloon angioplasty, stent implantation, rotational ablation, and directional coronary atherectomy. Satisfactory acute results for coronary balloon angioplasty can be obtained in patients in a relatively short interval from the onset of disease, especially within 6 years. However, the incidence of restenosis after angioplasty is still high. Stent implantation acquires larger luminal area, less restenosis rate and less aneurysmal formation than balloon angioplasty. Rotational ablation is a good interventional option with high success rate for longstanding Kawasaki disease with severe calcification. Intravascular ultrasound imaging provides valuable information for the selection of the appropriate interventional procedure and the assessment of postprocedural outcomes. To obtain good result and optimal decision making, cooperation between pediatric and adult cardiologists is essential. Postprocedural anticoagulation or antiplatelet regimens are required for proper long-term management.
Adult ; Aneurysm ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Decision Making ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Percutaneous Coronary Intervention ; Phenobarbital ; Stents ; Ultrasonography

The retrograde approach through a collateral artery is now thought to improve the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), and different kinds of strategies for this technique have been developed. However, the basic principles of PCI for CTO, such as firm back-up support with a guiding catheter and fine control of the guide wire, should be adhered to more strictly to succeed with this complex procedure. We present a case in which a CTO of the proximal left anterior descending artery was successfully opened by the retrograde approach through a collateral from the left circumflex artery, during which two guiding catheters were simultaneously used in the same coronary artery for the purpose of strong back up support for the retrograde device and fine control for the antegrade device.
Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Coronary Occlusion ; Coronary Vessels ; Percutaneous Coronary Intervention

We report the case of a 51-year-old man who presented with worsening exertional chest pain in whom subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Fortunately, the patient was stable and coronary angiography revealed resolution of the fistula 20 minutes later. This case study emphasizes the management of iatrogenic coronary perforations, depending on the type and severity of perforation, which generally involves initial conservative management.
Angioplasty, Balloon, Coronary ; Arteriovenous Fistula ; Chest Pain ; Coronary Angiography ; Fistula ; Humans ; Middle Aged ; Percutaneous Coronary Intervention