1/48. Spontaneous recanalization of postoperative severe graft stenosis. What is the cause and prognosis of the "string sign" in the internal thoracic artery?A 68-year-old female with unstable angina was treated surgically. She was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with three vessel disease. On a coronary angiogram (CAG), 90% stenoses were found in the left anterior descending coronary artery (LAD), circumflex (CX), and right coronary artery (RCA). She received elective coronary artery bypass grafting (CABG), in which the left internal thoracic artery (LITA) was anastomosed to the LAD and reversed saphenous vein grafts (SVG) were made to segment 12 of the CX, and segment 4PD of the RCA, respectively. The postoperative course was uneventful, but postoperative early graftgraphy revealed distal narrowing of the LITA graft as the so-called "string sign". However, one year post surgery, the LITA string sign was not found and its patency had markedly improved on the second graftgram. It is reported that the LITA "string sign" might cause late graft occlusion. However, this LITA graft evidently enlarged the size and increased the flow of the artery in proportion to myocardial blood demand. To our knowledge, it has not been reported that an in situ LITA string sign on postoperative early graftgram has disappeared in the late phase. We hypothesize that the LITA string sign might be caused by several different factors such as flow competition, spasm, and/or technical problems. In any event, the LITA string sign does not cause graft occlusion in the late postoperative period in every case.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
2/48. Severe cutaneous cholesterol emboli syndrome after coronary angiography.cholesterol embolization syndrome is due to dislodgment of cholesterol crystals from the atherosclerotic plaques lining the walls of major arteries resulting in an occlusion of small arteries. We describe a case of severe cutaneous cholesterol emboli syndrome following repeat coronary angiography showing by our observation that this syndrome is often unrecognized or misdiagnosed and that a better evaluation of risks factors in patients undergoing invasive procedures could prevent this severe complication.- - - - - - - - - - ranking = 0.5keywords = occlusion (Clic here for more details about this article) |
3/48. Minimally invasive axillary-coronary artery bypass for acute occlusion of the coronary artery.We performed minimally invasive axillary-coronary bypass using a reversed saphenous vein graft to treat a patient with acute occlusion of the left anterior descending artery after failed percutaneous transluminal coronary angioplasty (PTCA). For patients with acute myocardial ischemia, this procedure is useful to reduce the ischemic time and is less invasive. We believe this procedure may be an alternative intervention for selected patients with acute myocardial infarction or unstable angina after PTCA. However, a large series with sufficient follow-up and late angiography is required to evaluate the long-term patency and effectiveness of this approach.- - - - - - - - - - ranking = 2.5keywords = occlusion (Clic here for more details about this article) |
4/48. Refractory vasospasm with a malignant course.We present a patient with two rare disorders, recurrent vasospastic angina leading to cardiac transplant and acute aortic occlusion. The patient had recurrent episodes of coronary vasospasm presenting with unstable angina, acute myocardial infarction, and sudden cardiac death in spite of adequate therapy with nitrates and calcium-channel blockers. He went on to have a cardiac transplant. The patient later presented with acute aortic occlusion with concomitant renal and mesenteric artery spasm. The circumstances of the presentation raise the possibility of a generalized vasospastic predisposition that is responsible for both events. smoking, the only known major risk factor other than atherosclerosis, was noted to be temporally related to both events in our patient.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
5/48. Use of the multifunction probing catheter as an adjunctive device for occluded vein graft intervention.We describe the use of the multifunction probing catheter (Schneider, Bulach, switzerland) as an adjunct to conventional techniques in the treatment of a recent vein graft occlusion by thrombus, in order to highlight a possible further use for this device.- - - - - - - - - - ranking = 0.5keywords = occlusion (Clic here for more details about this article) |
6/48. Usefulness of coronary MR angiography prior to angioplasty.The range of indications for percutaneous transluminal coronary angioplasty (PTCA) has increased greatly since the procedure was initially introduced. The success rate depends on the anatomy and length of the occlusion and on the state of the distal vessel. We present a case where the use of magnetic resonance angiography (MRA) allowed to evaluate the length of a subtotal occlusion prior to PTCA, and thus could have had an impact on therapeutic decisions. Coronary MR angiography is one of the many applications of breathhold MRI, where breathholding and segmented k-space acquisition are combined to provide anatomical images of coronary vessels. Coronary MR angiography allows reproducible visualization of coronary vessels. Even under adverse circumstances (poor cardiac triggering) the images are sometimes of sufficient quality to help make a diagnosis. This capability may increase the as yet limited clinical use of MR technology in the practice of cardiology.- - - - - - - - - - ranking = 1keywords = occlusion (Clic here for more details about this article) |
7/48. Facilitation of stent retention and retrieval with an emboli containment device.A potential consequence of unsuccessful stent delivery is dislodgment of the stent from the delivery catheter resulting in embolization. Recently, an angioplasty guidewire incorporating a distal occlusion balloon (GuardWire) has become available. We describe how, when used for the prevention of distal embolization of atheromatous or thrombotic particles, this device may facilitate retention and retrieval of undeployed stents.- - - - - - - - - - ranking = 0.5keywords = occlusion (Clic here for more details about this article) |
8/48. Combined minimaly invasive surgery for coronary bypass and abdominal aortic occlusion.association of extracorporal assisted coronary bypass with peripheral vascular surgery is already commonplace in the therapeutic arsenal. This case report presents a combined cardiac and vascular surgery in a high risk patient, with unstable angina following myocardial infarction and critical ischemia of a single lower limb. Synchronous minimally invasive direct coronary bypass graft and extra-anatomic aorto-profundal bypass in one single sitting were performed. The procedure was successful at 6 months follow up. We believe that this type of synchronous procedure, minimising surgical aggression, could be effective in selected high risk patients.- - - - - - - - - - ranking = 2keywords = occlusion (Clic here for more details about this article) |
9/48. Calcified aneurysms in coronary arteries of a 48-year-old patient.This is a case report of a 48-year-old female patient with a compatible history of Kawasaki disease during childhood, who was admitted to the emergency coronary unit with unstable angina pectoris. coronary angiography identified two coronary aneurysms, one causing right coronary occlusion and the other causing severe obstruction of the left anterior descending coronary artery. coronary artery bypass surgery was indicated.- - - - - - - - - - ranking = 0.5keywords = occlusion (Clic here for more details about this article) |
10/48. coronary artery bypass grafting in a patient with brainstem ischemia.We describe a 54-year-old male with severe coronary artery disease and cerebrovascular disease including right cerebellar infarction, total occlusion of the bilateral vertebral arteries, brainstem ischemia, and right cerebral infarction with significant right carotid artery disease. Repeated percutaneous transluminal coronary angioplasty had been performed, however, unstable angina was developed despite maximal medical treatment. coronary artery bypass grafting was successfully undergone with use of propofol, application of the intra-aortic balloon pumping perioperatively, and mild hypothermic cardiopulmonary bypass with alpha-stat blood gas management. The importance of preoperative evaluation of the intracranial circulation and management of cardiopulmonary bypass are discussed.- - - - - - - - - - ranking = 0.5keywords = occlusion (Clic here for more details about this article) |
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