[Retrieval of embolized coronary stent: combination of various approaches]

Device embolization is a potentially serious complication of percutaneous vascular interventions. Various devices and techniques can be used for the retrieval procedure. Herein, we report the retrieval of a stent that slipped off the balloon in the left main coronary artery and then embolized to the right femoral artery in a 77-year-old male. The stent could not be retrieved by snare, but was removed from the coronary tree via a balloon advanced inside it. The stent then embolized into the right femoral artery. Using a balloon catheter advanced through the stent and then via a biopsy forceps advanced over a femoro-femoral wire loop, we were able to remove the stent from the patient. In conclusion, there is no proven standard method for the retrieval of embolized material. Different techniques and devices can be used depending on the creativity of the operator as well as the individual situation of the case.

Traditional coronary risk factors in healthy Turkish military personnel between 20 and 50 years old: focus on high-density lipoprotein cholesterol

OBJECTIVE

Previous studies presented the Turkish population as a typical example of nations with low levels of high-density lipoprotein cholesterol (HDL-c). Nevertheless, some recent studies opposed this suggestion. We aimed to examine the traditional cardiovascular risk factors in young-middle age male military professionals, focusing especially on HDL-c.

METHODS

In this observational and cross-sectional study, the data of 820 male military personnel between 20-50 years old (mean age: 35.3±6.9) who applied to the hospital for routine health examination were included. Blood biochemistry, arterial blood pressure and anthropometric measurements were noted. Statistical analysis was performed using Kruskal-Wallis test and ANCOVA.

RESULTS

The mean age was 35.3±6.9, body mass index was 25.8±3.4 kg/m2 and waist circumference was 93.1±8.7 cm. HDL-c, low-density cholesterol, triglyceride and fasting blood glucose levels were 47.6±11.3, 120.4±33.2, 150.4±86.4 and 96,6±13.0 mg/dL, respectively. Only 23.2% of the participants had HDL-c level less than 40 mg/dL. The ratio of current smokers was 40.7%. Almost 66% of the participants (n=545) were making regular exercise. Mean systolic and diastolic arterial blood pressures were 124.1±13.0 and 75.7±9.3 mm Hg, respectively.

CONCLUSION

The "mean" levels of traditional coronary risk factors were in almost "normal" limits in healthy young-middle age male military professionals that were examined. It must be emphasized that the HDL-c level, which was defined as "genetically low in Turks" in some previous epidemiologic studies, was not really low. This finding may be due to relatively favorable life style of the study population. On the other hand, some recent population studies in Turkey had found HDL-c levels higher than it was thought. This issue needs further clarification in specific age groups without sedentary lifestyle.

Successful percutaneous epicardial ablation of an accessory pathway located at the right atrial appendage

In patients with Wolff-Parkinson-White syndrome, difficulty in ablation of accessory pathways is associated with failures and recurrences. Epicardially located accessory pathways may require different management strategies when conventional ablation attempts fail. In particular, an epicardial accessory pathway communicating the right atrial appendage to the right ventricle is an extraordinary situation resulting in difficulties in ablation. Hereby, we report on a challenging case of percutaneous epicardial ablation of an epicardial accessory pathway located at right atrial appendage in a 28-year-old man with Wolff-Parkinson-White syndrome, who had a prior history of unsuccessful endocardial ablation. Percutaneous epicardial ablation may be a viable option obviating the necessity of surgical ablation procedures for difficult ablation cases with epicardial accessory pathways.