Asymptomatic, Delayed Migration of Intracoronary Stent in Pericardial Space: A Rare Phenomenon.
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ABSTRACT:
SUBMITTER: Chakraborty P
PROVIDER: S-EPMC8311145 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundUnderexpanded stent in heavily calcified coronary lesion is common and persists over years. It is related to long-term failure and negative outcomes. Treatment of this situation after many years with intracoronary lithotripsy (ICL-Shockwave®) could be an option.Case summaryWe report a case of a man with underexpanded coronary stent implanted 11 years earlier. Optical coherence tomography highlighted the mechanism of stent underexpansion showing the presence of calcium stones under the old struts. Intracoronary lithotripsy crushed calcium under the stent struts causing its geometric change (from elliptical to round shape) and a consequent better transmission of the true radial force of the old stent.DiscussionHeavily calcified coronary lesions lead to stent underexpansion which persists over years. Intracoronary lithotripsy could be a very late option to manage this unfavourable common result.
| S-EPMC7649517 | biostudies-literature
Project description:Given the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics and assesses the safety/toxicity of ICBT in this high-risk population.A retrospective analysis of patients treated with ICBT between September 2012 and December 2014 was performed. Patients with ISR twice in a single location were eligible. Procedural complications included vessel dissection, perforation, tamponade, slow/absent blood flow, and vessel closure. Postprocedural events included myocardial infarction, coronary artery bypass graft, congestive heart failure, stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours. A control group of patients with 2 episodes of ISR at 1 location who underwent percutaneous coronary intervention without ICBT was identified. Unpaired t tests and χ2 tests were used to compare the groups.There were 134 (78%) patients in the ICBT group with 141 treated lesions and 37 (22%) patients in the control group. There was a high prevalence of hyperlipidemia (>95%), hypertension (>95%), and diabetes (>50%) in both groups. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous coronary artery bypass graft being more common the ICBT group. Procedural complication rates were low in the control and ICBT groups (0% vs 4.5%, P = .190). Postprocedural event rates were low (<5%) in both groups. Readmission rate at 30 days was 3.7% in the ICBT group and 5.4% in the control group (P = .649).This is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5%) of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort.
| S-EPMC5506705 | biostudies-other
Project description: Not available
| S-EPMC7156978 | biostudies-literature
Project description:BackgroundIn-stent restenosis is a difficult percutaneous scenario if calcific neoatherosclerosis is the underlying aetiology.Case summaryA 69-year-old diabetic woman with a previous percutaneous coronary intervention on the left anterior descending coronary artery was readmitted for non-ST-elevation myocardial infarction. In-stent restenosis due to calcific neoatherosclerosis was observed by intracoronary imaging during the intervention. Intravascular lithotripsy was used successfully to fracture the underlying calcific plaque. However, the balloon ruptured during treatment although this did not damage the artery.DiscussionIntravascular lithotripsy is a promising tool for the treatment of extremely calcified lesions including calcific neoatherosclerosis of in-stent restenosis. Balloon rupture is a complication of this new percutaneous treatment that has not previously been described.
| S-EPMC7501907 | biostudies-literature
Project description:IntroductionInserting double j ureteral stents is considered a common practice in the urology field. With the wide range of use, many complications were reported.Case presentationWe are presenting a rare case of five years old boy that had a right renal stone with moderate hydronephrosis. Inserting a double j stent was the first procedure to relieve the obstruction. Metabolic studies were negative. Twelve days later, the double j stent migrated upward. As a result, we performed an open surgery to remove the stone and the double j. During surgery, we inserted a new double j stent that was removed six weeks later. Follow-up showed no complaints.DiscussionUpward migration of a double j ureteral stent in a child is considered a rare entity. We performed open surgery to remove the ureteral stent and the stone. Such complication in a child has not been reported widely.ConclusionWe aim to report an upward migration double j ureteral stent in a boy and how we dealt with it.
| S-EPMC9577489 | biostudies-literature
Project description:Percutaneous coronary intervention was performed in a flush in-stent right coronary artery chronic total occlusion. Successful retrograde recanalization was performed but the lesion was balloon undilatable as confirmed by intravascular ultrasound. High-pressure post-dilation with noncompliant and plaque modification balloons failed, but intravascular lithotripsy successfully expanded the lesion. (Level of Difficulty: Advanced.).
| S-EPMC8311198 | biostudies-literature
Project description:Background. Pericardial tamponade is a known life-threatening condition rarely reported in COVID-19 but has not been reported following asymptomatic SARS-CoV-2 infection. Its pathomechanism is still elusive. Case Summary. We report the case of a 66-year-old man with progressive shortness of breath and leg swelling due to new-onset heart failure and pericardial tamponade following asymptomatic SARS-CoV-2 infection. Ultrasound-guided placement of a pericardial drainage led to significant improvement of symptoms and revealed an exudative effusion. Throughout the diagnostic process, we were confronted with a systemic inflammatory syndrome suspicion of an induced autoimmune condition. After steroid pulse therapy and oral anticoagulation for subclavian vein thrombosis, the patient was discharged and followed in our outpatient clinic. Discussion. Patients with asymptomatic SARS-CoV-2 infection are at risk for developing life-threatening complications. Induced autoimmune conditions could be a potential explanation for late-onset pericardial tamponade in this population. A multimodal imaging approach is crucial in the diagnosis and characterization of cardiac inflammation. An interdisciplinary approach is essential. Awareness of uncommon cardiac complications following a SARS-CoV-2 infection is crucial for the initial assessment and the appropriate treatment of these patients.
| S-EPMC9553720 | biostudies-literature
Project description:A 54-year old, hypertensive female patient underwent percutaneous coronary angioplasty (PTCA) followed by stenting of calcified chronic totally occluded right coronary artery. The post dilation balloon catheter got stuck and snapped during manipulations in inflated position within the stent, which could not be retrieved by nonsurgical interventions. Emergency surgery was performed to retrieve the stent along with an inflated balloon, followed by vein patch closure of arteriotomy and reversed saphenous vein graft anastomosis to right coronary artery and left anterior descending artery on cardiopulmonary bypass.
| S-EPMC8081146 | biostudies-literature
Project description:BACKGROUND:Permanent cardiac pacemakers require invasive procedures with complications often related to long pacemaker leads. We are developing a percutaneous pacemaker for implantation of an entire pacing system into the pericardial space. METHODS:Percutaneous micropacemaker implantations were performed in 6 pigs (27.4-34.1 kg) using subxyphoid access to the pericardial space. Modifications in the implantation methods and hardware were made after each experiment as the insertion method was optimized. In the first 5 animals, nonfunctional pacemaker devices were studied. In the final animal, a functional pacemaker was implanted. RESULTS:Successful placement of the entire nonfunctional pacing system into the pericardial space was demonstrated in 2 of the first 5 animals, and successful implantation and capture was achieved using a functional system in the last animal. A sheath was developed that allows retractable features to secure positioning within the pericardial space. In addition, a miniaturized camera with fiberoptic illumination allowed visualization of the implantation site before electrode insertion into myocardium. All animals studied during follow-up survived without symptoms after the initial postoperative period. CONCLUSIONS:A novel micropacemaker system allows cardiac pacing without entering the vascular space or surgical exposure of the heart. This pericardial pacemaker system may be an option for a large number of patients currently requiring transvenous pacemakers but is particularly relevant for patients with restricted vascular access, young children, or those with congenital heart disease who require epicardial access.
| S-EPMC6050018 | biostudies-literature
Project description:IntroductionPrimary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology.Case presentationA 61-year-old Caucasian woman was admitted to our hospital complaining of exertional dyspnea due to a large pericardial effusion. Intrapericardial fluid volume declined after repeated pericardiocentesis, but the patient progressively developed a hemodynamically relevant pericardial constriction. Pericardiectomy revealed a pericardial mesothelioma. Subsequently, four cycles of chemotherapy (dosage according to recently published trials) were administered. The patient remained asymptomatic, and there was no recurrence of the tumor after three years.ConclusionPericardial mesothelioma should be considered and managed appropriately in non-responders to pericardiocentesis, and in patients who develop constrictive pericarditis late in their clinical course.
| S-EPMC2767155 | biostudies-literature