Volume 1 issue 1

Table of Content

Accidental stent deployment in aorta.

Akhtar Ali Bandeshah & Muhammad Omer Hashmi


Introduction: Unintentional stent migration into the aorta during percutaneous coronary intervention (PCI) presents an uncommon yet demanding scenario. This case report delves into a complex situation where such an incident occurred.

Case Presentation: A patient presented a distinct case involving inadvertent stent migration into the aorta during a complex PCI. To address the issue, the MINICRUSH technique was employed. The case’s complexities underscored the need for a strategic approach, and the significance of precise procedural execution was apparent. The procedural intricacies and challenges of managing iatrogenic aorto-ostial coronary lesions are detailed.

Management & Results: The patient’s condition was effectively managed using the MINICRUSH technique. This involved strategic stent crushing in the mid left anterior descending artery (LAD)/diagonal 1 (D1) segment, successfully resolving the complication. The execution of the MINICRUSH approach demonstrated its efficacy in tackling complex challenges arising from stent migration into the aorta. The accurate positioning of the stent played a crucial role in achieving optimal clinical outcomes.

Conclusion: This report highlights the successful use of the MINICRUSH technique to manage inadvertent stent migration into the aorta during complex PCI, emphasizing precise procedural execution and stent placement’s significance.

An upfront two-stent strategy for bifurcation stenting of left anterior descending artery in acute coronary syndrome

Mohammad Naeem Malik & Muhammad Shoaib


Introduction: This case report presents a unique and noteworthy instance of bifurcation stenting in the left anterior descending coronary artery (LAD) during acute coronary syndrome (ACS). Bifurcation lesions are complex and challenging to treat, and this case contributes valuable insights to the scientific literature by showcasing successful management of LAD bifurcation in the context of ACS.

Case Presentation: The patient, a 50-year-old male with a history of hypertension and hyperlipidemia, presented to the emergency department with severe chest pain and electrocardiogram (ECG) changes indicative of ACS, with raised cardiac troponins. Urgent coronary angiography was planned, which revealed a significant stenosis at the bifurcation of the LAD.

Results: Given the complexity of the lesion and the high-risk presentation, the patient underwent percutaneous coronary intervention (PCI) with a bifurcation stenting approach. A drug-eluting stent was deployed at the LAD bifurcation site using a DK crush technique. The procedure was successful, with restoration of blood flow and resolution of chest pain. The patient was closely monitored and received dual antiplatelet therapy post-PCI.

Conclusion: This case underscores the importance of a tailored approach to treat bifurcation lesions in ACS patients. It highlights the feasibility and efficacy of a two-stent technique for bifurcation stenting in the LAD during ACS. The successful outcome demonstrates that careful planning, expertise, and appropriate stenting strategies can lead to favorable results in complex scenarios. Nevertheless, more research and clinical studies are warranted to establish the best management strategies for such cases, contributing further to the advancement of interventional cardiology.

Precision Care in Isolated Ostial Left Main Coronary Artery Disease: A Guided Approach

Zain Mehmood Butt, Naveed Iqbal & Shehzad Tawwab


Introduction: Introduction: Isolated ostial left main coronary artery (LMCA) disease, a rare condition more prevalent in middle-aged females, presents unique diagnostic and therapeutic challenges. This case report highlights the importance of early diagnosis and tailored interventions for effective management. 

Case Presentation: A 45-year-old female with hypertension presented via the emergency room with typical ischemic chest pain. Elevated troponin levels, generalized ST-T depressions on ECG, and isolated critical ostial disease of the left main stem on angiography were evident. Clinical history, symptoms, and angiographic findings were notable.  

Results: Due to high TIMI risk score, early catheterization was pursued. Utilizing a “hit and run” strategy, a preloaded Balloon on guide wire within guider before engagement and rapid balloon inflations were employed to minimize ischemic complications. Post-stenting, non-selective guide engagement was employed to prevent stent deformation. The patient’s post-procedure course was uneventful, and she was discharged in stable condition with guideline-directed therapy. One-year follow-ups showed medication adherence and good clinical progress.

Conclusion: Isolated LMCA ostial disease, though rare, presents substantial diagnostic and therapeutic complexities. Timely diagnosis and customized interventions are paramount for effective management. The case underscores considering this condition in specific patient groups, excluding coronary artery spasm, using controlled contrast injections, applying the “hit and run” technique, and utilizing available imaging. The core lesson is that a personalized approach enhances outcomes and prognosis in this infrequent ailment.

Enhancing Stent Apposition in ACS: IVUS-Guided Primary PCI Case Study

Hamza Ghafoor & Tariq Abbass


Introduction: Primary PCI is pivotal in ACS management. IVUS enhances stent apposition and plaque rupture understanding. Challenges encompass patient hemodynamics and complications.

Case Presentation: A case of acute AWMI underwent primary PCI with IVUS guidance. Pre and post stent deployment IVUS was employed without complications.  

Results: IVUS suggested a mid-LAD stent size of 4.5. Post-deployment, 4.5 NC led to under deployment, necessitating 5.0x12mm NC post-dilatation. IVUS improved stent apposition beyond typical 3.5mm diameter.

Conclusion: IVUS-guided primary PCI in AWMI showcases stent optimization’s potential benefits. Despite challenges, IVUS aids apposition. Individualized approach improves outcomes.

Waseem Ashraf & Waqas Jamil


Introduction: Left anterior descending artery (LAD) stenosis presents grave risks including myocardial infarction, heart failure, and mortality. While coronary artery bypass grafting is a preferred option, some cases require percutaneous coronary intervention (PCI) due to contraindications for surgery. In situations where heavily calcified LAD vessels complicate revascularization, rotational atherectomy (RA) emerges as an advanced technique. This case study explores the successful application of PCI with RA in managing LAD-related reversible ischemia, highlighting patient selection and intravascular ultrasound (IVUS) guidance.

Case Presentation: A female patient exhibited reversible LAD ischemia, carrying high risks of adverse cardiac events. Unsuitable for surgical intervention, PCI with RA was considered. Intravascular ultrasound confirmed severe calcification, guiding procedural planning. Under guidance, RA effectively addressed the calcified plaque, followed by stent placement to restore blood flow. IVUS post-stenting confirmed optimal stent expansion and apposition.

Results: Utilizing RA in PCI achieved successful revascularization of the heavily calcified LAD. IVUS played a crucial role, ensuring precise lesion assessment, plaque modification, and stent optimization. Post-PCI, the patient experienced symptom relief and enhanced myocardial perfusion. Follow-up revealed sustained improvements in symptoms and cardiac function, reinforcing the efficacy of this approach.

Conclusion: In cases unsuitable for surgical revascularization, PCI with rotational atherectomy proves valuable for treating heavily calcified LAD lesions. This study emphasizes thorough patient evaluation, precise lesion assessment via IVUS, and careful procedural planning. The successful outcome underscores RA-assisted PCI’s potential to improve patient well-being and address LAD stenosis-induced ischemic risks, advocating its integration for challenging LAD cases.

Successful Management of Left Main Bifurcation Lesion Using Culottes Technique.

Faisal Ahmed, Saadia Abubakar & Falaknaz Salari


Introduction: In the realm of complex coronary bifurcating lesions, selecting an optimal treatment strategy poses challenges that demand expertise. This case study presents a middle-aged male with unstable angina, successfully undergoing percutaneous coronary intervention (PCI) using the Culottes technique.

Case Presentation: The patient, a middle-aged male, presented with unstable angina and was diagnosed with a complex coronary bifurcating lesion. The lesion’s intricate nature required careful consideration of the treatment approach. Given the challenges associated with bifurcation lesions, a strategic intervention was essential to ensure the best possible outcome.

Results: The patient underwent percutaneous coronary intervention (PCI) utilizing the Culottes technique. This approach involves the use of two stents to treat both the main vessel and the side branch simultaneously. The procedure was conducted successfully, resulting in symptom relief for the patient. Subsequent to the intervention, the patient experienced a significant improvement in his condition, enabling him to resume his daily activities without discomfort.

Conclusion: This study emphasizes the intricacies of bifurcation lesion treatment and underscores Culottes as a viable approach, encouraging improved patient outcomes and quality of life.

Bifurcation Stenting with Internal Crush (Reverse Crush) technique as a bailout in Acute coronary Syndrome

Hasan Sohail, Khursheed Hassan, Salman Ishaq & Muhammad Amin  


Introduction: Percutaneous coronary intervention (PCI) during acute coronary syndrome (ACS) involving bifurcation stenting presents heightened complications and intricacy. This case report showcases a 66-year-old woman with high-risk ACS and extensive coronary artery disease, featuring a total left anterior descending artery (LAD) occlusion. The case highlights the complexity of PCI in ACS, especially with bifurcation stenting.

Case Presentation: The patient, a 66-year-old woman, exhibited high-risk ACS with triple vessel coronary artery disease and complete LAD occlusion on angiography. The initial strategy aimed to restore LAD flow, followed by Coronary artery bypass grafting (CABG). However, her condition deteriorated due to severe no-reflow unresponsive to intracoronary vasodilators. In response, a left main (LM) to LAD PCI was performed to stabilize the patient. The case further elaborates on the internal crush bifurcation stenting technique and subsequent PCI of the right coronary artery (RCA), all undertaken within the same hospitalization for comprehensive revascularization.

Results: The patient’s critical ACS necessitated swift decision-making. Severe no-reflow in the LAD, resistant to vasodilators, prompted a LM-LAD PCI to stabilize the situation. The report discusses the internal crush bifurcation stenting method used, providing insights into its technical aspects and implications. Furthermore, the PCI of the RCA during the index hospitalization for full revascularization is detailed, highlighting the comprehensive approach employed.

Conclusion: This case underscores the dynamic and critical nature of ACS management, requiring prompt decisions and adaptability. The successful execution of internal crush bifurcation stenting as a bailout strategy in this context demonstrates the potential for this technique in specific clinical scenarios. Timely interventions, such as LM-LAD PCI, are crucial to stabilizing patients in high-risk ACS situations, ultimately contributing to improved outcomes. The case emphasizes the importance of considering multifaceted strategies and techniques when managing complex ACS cases with bifurcation stenting challenges.

Percutaneous coronary intervention (PCI) for Chronic Total Occlusion (CTO) of Left Descending Artery (LAD)

Muhammad Yasir & Ayesha Iqbal


Introduction: This case report highlights a novel approach in the management of refractory angina by utilizing advanced interventional techniques for Chronic Total Occlusion (CTO) lesions. While conventional interventional cardiology tends to avoid treating CTO due to potential complications, this case presents an innovative strategy that challenges the status quo and contributes to the scientific literature.

Case Presentation: The patient under study presented with refractory angina, a condition characterized by persistent chest pain despite medical treatment. The focus was on a CTO lesion, which traditionally poses high risks and often necessitates surgical intervention. However, in this instance, the patient’s condition and suitable anatomical characteristics made them a candidate for an alternative approach.

Results: The management involved the use of advanced CTO equipment and endovascular methods, deviating from the conventional surgical route. The chosen Percutaneous Coronary Intervention (PCI) approach proved successful, resulting in the complete resolution of the CTO lesion. This intervention led to a notable improvement in the patient’s overall cardiac function, both regionally and globally, as evidenced by follow-up assessments.

Conclusion: This case underscores the potential of advanced CTO PCI techniques in managing refractory angina patients with appropriate anatomical features. The positive outcomes challenge the conventional notion of exclusively opting for surgical intervention for CTO cases. The successful application of this innovative strategy not only expands the therapeutic options available but also underscores the importance of expert intervention and specialized equipment.