Angioplasty Of Right Coronary Artery Research Articles

Right coronary artery intervention through right radial access in a patient with aberrant right subclavian artery and anomalous origin of right coronary artery

We report a case of primary angioplasty of right coronary artery (RCA) through right radial artery access in a patient with aberrant right subclavian artery (arteria lusoria) and anomalous origin of RCA. Major challenges in such cases are difficulty in hooking coronary ostia and getting enough support from the guide catheters. However, another challenge confronted in this patient was the anomalous origin of RCA from the left sinus. Herein, we discuss key aspects of management in this scenario. Arteria lusoria with anomalous RCA can be confronted during the transradial intervention. Use of an appropriate guide catheter to facilitate the procedure in this scenario can help interventionists to manage such a situation, and this can be a useful alternative in those patients with unfavorable transfemoral access along with this rare anomaly.

Balloon coronary angioplasty and parenteral antiplatelet therapy for intraoperative myocardial infarction during general surgery: An attempt to balance benefits and risks - a case report

Introduction. Cardiovascular complications remain one of the major risk factors for perioperative morbidity and bad outcome in non-cardiac surgery patients. Here we report a case of the patient suffering intraoperative ST-segment elevation acute myocardial infarction (STEMI) promptly treated with percutaneous balloon angioplasty and intravenous antiplatelet agents. Case report. A 62-year-old man, without previous history of cardiovascular morbidity, developed STEMI during abdominal surgery. Due to profound hypotension with mean arterial pressure of less than 40 mmHg, surgery was promptly ended and patient transferred to intensive care unit. Within one hour after the end of the surgery, coronary angiography and successful balloon angioplasty of occluded right coronary artery were performed. Tirofiban infusion was started in recommended dose. Developed hemodynamic instability was related to hypovolemia and excessive drainage, reaching 1,500 mL of blood in the following 15 hours. The following morning, drainage persisted (additional 600 mL of blood) which resulted in profound hypotension (65/40 mmHg). Overall, the patient received 1,970 mL of blood, 6 doses of thrombocytes and 840 mL of fresh frozen plasma. All together, the patient had a favorable outcome, despite the occurrence of bleeding complications and hemodynamic instability. Conclusion. The choice of treatment strategy for patients suffering perioperative STEMI during major non-cardiac surgery is challenging. After major non-cardiac surgery, characterized by both high bleeding risk and high risk of stent thrombosis, balloon angioplasty instead of stenting along with parenteral antiplatelet treatment may be a fair therapeutic choice. Clinical choices have to be made individually, according to the weighted risks and benefits.

Balloon assisted trapping (BAT) and retrieval of fractured and impacted coronary angioplasty balloon catheter: simple solution to a complex problem

Fracture of catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication, which may result into embolization or impaction leading to complete or near complete occlusion of respective territory, arrhythmia, or rarely sudden death. Here, we report an unusual complication of a broken balloon catheter during angioplasty of a calcified right coronary artery in a 78-year old female which was successfully retrieved by balloon assisted trapping in guiding catheter.

Acutely onset amiodarone-induced angioedema in a patient with new atrial fibrillation.

A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA) with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF). Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field.

PCI in ARCA

Angioplasty of anomalous coronary arteries can be technically challenging because of the difficulty in selectively cannulating the aberrant vessel. I present my experience with angioplasty of an anomalous right coronary artery. A 6- Fr amplatz left 1 guiding catheter was used to obtain stable position in the right coronary artery and angioplasty was performed.

Primary angioplasty of an anomalous right coronary artery arising from the left sinus of Valsalva

Primary angioplasty of an anomalous right coronary artery arising from the left sinus of Valsalva

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.

Should All Patients With Asymptomatic but Significant (>50%) Left Main Coronary Artery Stenosis Undergo Surgical Revascularization?

The incidental detection of asymptomatic but significant (>50%) left main coronary artery disease (LMCAD) has become more frequent with the increased use of coronary angiography for acute myocardial infarction. Most would agree that such LMCAD cannot be ignored. Yet, clarity is somewhat lacking as to the best approach to managing such patients. The long-running debate of the best revascularization method of LMCAD has flared up again. However, medical management also may be a viable option for some of these patients. A 64-year-old nondiabetic man without a history of cardiovascular disease is admitted with an acute inferior ST-elevation myocardial infarction. He undergoes successful primary angioplasty of a dominant right coronary artery. Left ventriculography reveals inferior hypokinesis with an estimated ejection fraction of 45% to 50%. However, the patient also has a smooth mid-to-distal 60% LMCAD without any significant lesions in the left anterior descending or left circumflex artery. A month later, a stress echocardiogram reveals no new wall motion abnormalities. On the basis of this presentation, should he be referred for coronary artery bypass graft (CABG) surgery? The American College of Cardiology/American Heart Association (ACC/AHA) 2002 guidelines for stable angina1 discuss the indications for CABG surgery separately for symptomatic and asymptomatic LMCAD, but the recommendations are the same for both: Revascularization with CABG is a class I recommendation with level of evidence B. (Class I recommendations indicate situations for which evidence or general agreement exists that a given procedure or treatment is beneficial, useful, and effective.) An abbreviated version of these same guidelines was published in 2003.2 These guidelines acknowledged that the evidence behind the recommendation for asymptomatic patients is weak, yet the class IB recommendation was not changed. The ACC/AHA 2004 guidelines for use of CABG surgery also separate symptomatic and asymptomatic LMCAD recommendations and propose that CABG …

Coronary artery perforation complicated by cardiac rupture during conventional PCI

A 65-year-old female hypertensive, hypercholesterolaemic patient on medical therapy for stable angina presented with worsening symptoms. Coronary angiogram revealed a left coronary artery (LCA) with a 50% stenosis and a right coronary artery (RCA) subocclusion (Panel A). The patient underwent RCA angioplasty. The RCA subocclusion was crossed with guide wire, and multiple dilatations were performed using 2.0/18 and 2.5/20 mm balloons (Maverick, Boston Scientific). Two driver stents (24/3.5 and 30/4.0 mm, …

Surgical angioplasty of the left main coronary artery and/or proximal segment of the right coronary artery by pulmonary autograft patch.

There are controversial opinions about the expediency of performance of the surgical angioplasty of the left main coronary artery (LMCA) and/or proximal segment of the right coronary artery (RCA) in rare cases of isolated lesion or with limited involving of distal coronary branches. One of the many fears restraining a wider performance of this operation is the uncertainty in longevity of patch material. It is supposed that the autovein has tendency to proliferating degeneration similar to that in case of coronary artery bypass grafting (CABG), while the autopericardium may be subjected to calcification. Autoarterial patches have a limited width. To withdraw these real or hypothetical negative properties of patch materials we offer to harvest the pulmonary autograft patch (PAP) for coronary angioplasty. Our experience with PAP-angioplasty of LMCA and/or proximal segment of RCA includes four cases. Simultaneous angioplasty of LMCA and proximal segment of RCA was performed in one patient; angioplasty of LMCA--in two patients; angioplasty of RCA--in one patient. In two cases the stenosis of LMCA was accompanied by stenotic lesion of left anterior descending coronary artery (LAD). The surgical approach to LMCA was performed by complete crossing of pulmonary artery (PA). There was no necessity to use any plastic material for restoring of PA integrity in all cases. All patients survived after the operation. The postoperative course was uncomplicated except one case of LMCA/LAD lesion. There was a temporary low cardiac output syndrome and ventricular arrhythmia resulting in additional CABG as 'back-up' procedure. This complication was not a consequence of impassability of LMCA because its good patency was established at control coronary angiograms. The postoperative coronary angiograms were performed in all cases. They showed a satisfactory width of the main coronary vessels. The maximal follow-up period is 30 months. We suppose that the use of viable pulmonary autograft patch for surgical angioplasty of LMCA and proximal segment of RCA removes one of a lot of fears, which restrain the wider use of this alternative to CABG operation.

Echocardiographically documented acute aortic insufficiency induced by Amplatz left guide catheter

This paper examines a case of sudden systolic pressure fall, tachycardia, low pulse pressure, and high pulmonary artery wedge pressure due to acute aortic insufficiency which was induced by an Amplatz left (AL-1) guide catheter used for better guide support during percutaneous transluminal coronary angioplasty of the right coronary artery. AL guide catheters can cause acute aortic insufficiency, of which practitioners should be aware when sudden hemodynamic collapse occurs.

Resolution of exercise intolerance secondary to ischemic sinus node dysfunction following percutaneous transluminal angioplasty

We report on a case of significant exertional symptoms secondary to occlusion of a nondominant right coronary artery proximal to the sino-atrial branch, with associated exercise-induced sinus node dysfunction. Successful angioplasty of the occluded right coronary artery restored a normal functional capacity and sinus tachycardia response to exercise. Cathet. Cardiovasc. Diagn. 42:44–47, 1997. © 1997 Wiley-Liss, Inc.

Acute myocardial infarction associated with dobutamine stress echocardiography

Acute myocardial infarction as a complication of dobutamine stress echocardiography (DSE) is described in two patients during or shortly after undergoing the procedure. Both clinical events resulted in characteristic elevations in cardiac enzymes and the development of new electrocardiographic Q waves in the inferior leads. Subsequent coronary angiography was performed in both cases; one patient required two-vessel coronary artery bypass grafting to his first obtuse marginal and posterior descending arteries, and the other underwent successful angioplasty of an occluded proximal right coronary artery. Only two cases of DSE-associated myocardial infarction have been reported previously in the literature.(J Am Soc Echocardiogr 1997;10:576-8.)

Coronary angioplasty of anomalous right coronary artery originating from the left sinus of Valsalva

Coronary angioplasty of an anomalous coronary artery can be technically challenging because of difficulty in cannulating the aberrant vessel and in obtaining a stable guiding catheter position. Only three cases with the right coronary artery originating from the left sinus of Valsalva were previously reported. We present a new case in which a successful angioplasty was obtained using a Williams LR guiding catheter.

Hugging balloon angioplasty of right coronary artery

We report a case of "hugging balloon" dilatation of a giant right coronary artery using two dilatation catheters, a balloon "on a wire" and a balloon "rapid exchange" systems via a single guiding catheter. The necessity of larger PTCA balloon catheter (> 4.0 mm) was stressed.

Percutaneous transluminal angioplasty of anomalous right coronary artery arising from the ascending thoracic aorta

Coronary arteries with anomalous aortic origin are infrequently encountered in patients undergoing cardiac catheterization and pose potential technical difficulties for performing both diagnostic and angioplasty procedures. Percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic disease in anomalous right coronary artery (RCA) has been described in only a few reports. In all the cases reported to date, the anomalous vessel arose from the left sinus of Valsalva. We report a case of a technically straight-forward PTCA performed in an anomalous RCA arising from the anterior aspect of the ascending thoracic aorta.

Initial clinical results with the wiktor stent: A new balloon‐expandable coronary stent

The Wiktor stent, a new coronary balloon-expandable tantalum stent, was implanted in 17 patients for other wise nonmanageable occlusion after balloon angioplasty (n = 11) and for recurrent restenosis (n = 6). Stents of 3.0 to 4.0 mm were implanted (right coronary artery: n = 10, left anterior descending artery: n = 4, left circumflex artery: n = 2, venous graft: n = 1). All patients were fully anticoagulated initially with heparin followed by coumadin for 3 months and were treated with acetylsalicylic acid indefinitely. Due to its good radiopacity, the device could be placed easily without complications. Early occlusion occurred in one patient after 8 h probably due to friable atheromatous material prolapsing between the meshes of the stent. Late occlusion occurred in another patient who was admitted in cardiogenic shock after pre-hospital reanimation and was stented after occlusive disection following balloon angioplasty of an occluded right coronary artery. In this patient with severe hypoxic brain damage, reocclusion and reinfarction to which the patient finally succumbed occurred following cessation of anticoagulation. Histology demonstrated occlusive thrombosis without evidence of a neointimal covering of the stent. Another thrombotic occlusion due to inadvertent omission of anticoagulation occurred in another patient two weeks after stenting. Control angiography after 6 months in 12 patients revealed restenosis in two patients (50% and 80%). The patient with 80% restenosis of the right coronary artery and pathologic results during stress testing underwent surgical revascularization. The other patient with a 50% restenosis of the right coronary artery was managed medically as he was asymptomatic and without evidence of ischemia during stress testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Is ST elevation the only electrocardiographic response of the ischemic right ventricle?

Right ventricular (RV) infarction is frequently associated with transient ST elevation in right precordial leads 1,2. Studies of patients with an inferior infarction have shown that right precordial ST elevation is predictive of a proximal right coronary artery (RCA) occlusion 3, and that the duration of the ST elevation is predictive of the extent of early RV dysfunction 4. The spectrum of electrocardiographic response to ventricular ischemia is well described in the left coronary distribution 5–7 but not in the RCA distribution. Stenosis of the proximal RCA before the major RV branches is uniformly associated with exercise-induced right precordial ST elevation 8–10. Proximal RCA lesions have also been associated with a reduction in RV ejection fraction during exercise and during balloon occlusion. 11,12 Two studies of 8 and 13 patients undergoing RCA angioplasty showed right precordial ST elevation, but did not report the occurrence of right precordial ST depression 13,14. This study was performed prospectively to determine the electrocardiographic response in V 4R in consecutive patients undergoing coronary angioplasties, using angioplasty as a model of reversible ischemia. We hypothesized that ischemia during proximal RCA angioplasty would be similar to exercise-induced ischemia—that is, ST elevation and not ST depression would be seen in the right precordial leads.

Percutaneous transluminal coronary angioplasty of anomalous right coronary artery

Coronary angioplasty of tortuous anomalous coronary arteries can be technically challenging. We describe a successful percutaneous transluminal coronary angioplasty (PTCA) of an anomalous right coronary artery after a failed previous attempt. The anatomic limitations of anomalous right coronary arteries and technical considerations for PTCA are discussed.

Acute coronary occlusion after percutaneous transluminal angioplasty of the right coronary artery

Percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA), especially the proximal segment, has been reported to be a risk factor for acute coronary occlusion, 1,2 a point that has not been confirmed in more recent studies. 3 While intimal dissection at the site of dilatation seems to be the predominant mechanism, coronary thrombosis, embolization to distal segments, wall perforation or spasm can also lead to this major complication. 4,5 Certainly, improved operator experience and equipment have contributed to the decrease in acute coronary occlusion; yet it remains the major cause for morbidity and mortality associated with PTCA. 6 This study evaluates angiographic causes of acute occlusion for single-artery, single-stenosis PTCA of each of the 3 major coronary arteries to obtain a better idea of any inherent risks associated with RCA angioplasty.