Successful deployment of polytetrafluoroethylene-covered stent to seal left internal mammary artery graft perforation due to guide catheter extension system

Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature

BACKGROUND

Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening.

CASE PRESENTATION

A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period.

CONCLUSIONS

Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.

An asymptomatic Lima dissection after a programmed hybrid revascularization procedure turned to nightmare

A 71-year-old female with symptomatic bitroncular coronary ischemic disease was admitted in our hospital for hybrid revascularization. She presented significant stenosis of the proximal and middle left anterior descending artery (LAD) and of the second segment of right coronary artery (RCA). She was scheduled for an Endoscopic Atraumatic Coronary Artery Bypass (EACAB) of the left internal mammary artery (LIMA) to LAD and staged percutaneous coronary intervention (PCI) to RCA after the EACAB. Control of LIMA permeability after RCA PCI showed LIMA dissection with TIMI 2 flow to LAD. Decision to stent a freshly implanted LIMA led to LIMA rupture. An emergent LAD revascularization with a saphenous vein graft and control of bleeding was successfully performed. Patient was discharged at day 10 from the hospital.

Perforation of a Saphenous Vein Graft Anastomosed at a Y-Configuration to the Left Internal Mammary Artery

Perforation of a saphenous vein graft (SVG) is a rare, yet dreadful complication during percutaneous coronary intervention (PCI). Perforation of a SVG arising at a Y-construction from the left internal mammary artery (LIMA) can be catastrophic since manipulations and material delivery through the single LIMA inflow can aggravate ischemia and accelerate hemodynamic collapse. Prior CABG and pericardial obliteration should not offer reassurance against tamponade, since coronary perforation in these patients may cause the development of loculated pericardial effusions, a complication associated with high mortality. Treating physicians must be alert for potential periprocedural pitfalls during PCI in post-CABG patients and these should be taken into consideration during interventional planning, procedure and follow-up.