Fracture of popliteal artery stents

In peripheral arterial obstructive disease, more than 50% of all lesions are localized in the femoropopliteal segment and surgical revascularization is the treatment of choice. Percutaneous transluminal angioplasty (PTA) is recommended for short lesions, with subsequent stent implantation if the result is sub-optimal or dissections occur after PTA or for restenosis. There are both acute and late complications with stent implantation. In the present patient, stents were placed in the left popliteal artery where the left knee joint flexes, and obstruction because of stent fracture occurred 6 months later. The patient eventually underwent left femoro-popliteal saphenous vein bypass grafting

A chronic coronary pseudoaneurysm after stent implantation

Recently, as a part of new stent implantation strategy in order to decrease stent thrombosis, final dilatations with high pressure and/or higher sized balloons were applied after the initial deployment of the stent. In this paper, we presented a case of chronic coronary pseudoaneurysm which occured after an initially successful stent implantation in the left anterior descending artery, probably due to high pressure final dilatation

Rescue coronary stenting with heparin-coated Jostents for failed thrombolysis in acute myocardial infarction

The aim of the present study was to assess the procedural safety and in-hospital and long-term effectiveness of heparin-coated Jostents after failed thrombolysis in acute myocardial infarction. We prospectively analyzed the acute and long-term clinical and angiographic outcornes of 35 consecutive patients treated with heparin-coated Jostents for thrombolytic failure. Rescue coronary stenting was successful in 34 of 35 patients (97%). Thrombolysis in Myocardial Infarction flow grade 3 was obtained in 31 patients (88.5%). The only patient with procedural failure died from cardiogenic shock a day after the procedure. One patient (2.8%) underwent an emergency coronary bypass operation because of angiographic evidence of stent thrombosis with re-infarction. During in-hospital follow-up, 2 patients (5.7%) underwent an elective coronary bypass operation after successful stent implantation of the infarct-related artery because of existing severe multivessel coronary artery disease. Minor bleeding complications at the vascular access site occurred in 3 (8.6%) patients. No cerebrovascular or any other major bleeding complication occurred. One patient (2.1%) underwent repeat coronary angioplasty for restenosis and an elective coronary artery bypass operation was performed in one patient (2.8%) during the 294 +/- 150 days follow-up. The rate of target vessel revascularization was 14.3% and the event-free survival rate was 80%. Twenty-six patients (90%) had angiographic follow-up at six months, and stent restenosis was found in 5 (19.2%). This study demonstrates that heparin-coated Jostents are safe, with low in-hospital and long-term mortality fates for the treatment of failed thrombolysis in acute myocardial infarction. The angiographic restenosis and target vessel revascularization rates of this registry are also acceptable

Zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost

Stent fracture is a rare complication of drug-eluting stent implantation with a reported rate of 0.84%–3.2% in various clinical studies with first-generation drug-eluting stents and 29% in autopsy studies. Sirolimus-eluting stents with their closed cell design were reported to be more prone to fracture compared to paclitaxel-eluting stents. Other risk factors for stent fracture are multiple stenting, longer stent length, chronic renal failure, right coronary artery intervention, and a higher maximal inflation pressure. The role of angiography in diagnosing stent fracture is limited, a fact also questioning the reliability of angiographic data. Image enhancement techniques like StentBoost are widely available in new-generation angiography systems and are used to assess stent expansion, overlap size, or to localize the postdilation balloon. Here, we report a case of zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost

Revascularization of chronic coronary artery occlusions using laser debulking followed by stent implantation

Objective - Chronic total occlusions are considered unfavourable for percutaneous balloon angio-. plasty because of the low rate of success and the high rate of restenosis. Stent implantation after recanalization of chronic total occlusions has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would improve the benefit of stenting in chronic total occlusions

Congenital absence of the left circumflex coronary artery and an unusually dominant course of the right coronary artery

Congenital absence of the left circumflex artery (LCX) is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report on a 55-year-old female with atypical chest pain. Routine coronary angiography showed a normal left anterior descending coronary artery (LAD), no LCX and a dominant right coronary artery (RCA), which continued beyond the crux, running the full course of the LCX and terminating in the left atrial branch. Neither aortography nor pulmonary angiography showed a separate ostium for the LCX. There were no atherosclerotic lesions in the coronary arteries, or ischaemia on stress myocardial perfusion imaging. Multi-detector row computed tomography (MDCT) was performed to confirm the diagnosis

Increased secretion of insulin during oral glucose tolerance test can be a predictor of stent restenosis in nondiabetic patients

Insulin is known to stimulate proliferation and migration of vascular smooth muscle cells. As the predominant mechanism of restenosis after stent implantation is neointimal tissue proliferation, one can expect a relationship between hyperinsulinemia and restenosis in these patients. The aim of this study was to determine whether hyperinsulinemia during oral glucose tolerance test is a predictor of the development of restenosis after stent implantation in nondiabetic patients. We prospectively studied 52 nondiabetic patients with effort angina who underwent elective stent implantation for single-vessel coronary artery disease. In order to increase the statistical power of the study, numerous exclusion criteria were applied. All patients were subjected to a 75 g oral glucose tolerance test a day before the stent implantation and underwent follow-up angiography 6 months later. Plasma insulin levels in fasting (6.77 +/- 1.57 vs. 5.36 +/- 1.35 muU/ml; P = 0.005), at 30 min (102.48 +/- 10.6 vs. 47.74 +/- 12.75 muU/ml; P = 0.001), 1 hr after (120.23 +/- 14.1 vs. 63.08 +/- 12.62 mu/ml; P = 0.001), 2 hr after (63.58 +/- 8.64 vs. 34.88 +/- 6.82 mu/ml; P = 0.001), and 3 hr after (25.71 +/- 5.65 vs. 23.02 +/- 4.61 mu/ml; P = 0.04) loading were significantly higher in patients with stent restenosis than in patients without stent restenosis. Insulin area and insulin area/glucose area were also significantly higher in patients with stent restenosis than in patients without (219.5 +/- 23.8 vs. 118.9 +/- 21.8, P = 0.001, and 0.62 +/- 0.09 vs. 0.33 +/- 0.06, P = 0.001, respectively). By multiple logistic regression analysis, insulin area during oral glucose tolerance test was found to be an independent predictor of stent restenosis (OR = 1.12; 95% CI = 1.01-1.25; P = 0.031). In conclusion, nondiabetic patients with hyperinsulinemia during oral glucose tolerance test have a high risk for restenosis after stent implantation, and performing this simple test before intervention may be useful for the prediction of stent restenosis