Coronary anomalies are rare congenital malformations that are associated with an increased risk of arrhythmias, ischemic events and sudden death. Many remain asymptomatic throughout the patient’s life, and are diagnosed incidentally by imaging tests. The treatment is necessary when ischemia is confirmed or in the presence of symptoms, and surgical intervention is the method of choice. However, some studies allow percutaneous treatment to be used as an alternative, especially in anomalies of the right coronary artery. In view of this, the objective of this study was to report three cases of congenital malformation of the right coronary artery treated by percutaneous coronary intervention.

Background: The treatment of coronary arteries with heavily calcified or chronically occluded lesions has the lowest success rates when they undergo a percutaneous procedure. A strategy to reduce the volume of calcified lesions, which was part of the rescue technique to treat non-balloon dilatable stenoses, has evolved to an approach of primary lesion preparation for subsequent stenting. Methods: This is a retrospective analysis of data related to rotational atherectomies performed in complex, high-risk patients, for treating extremely calcified lesions with drug-eluting stent implantation, obtained from the Tasy Electronic Medical Record, between 2012 and 2016. Results: A cohort of 138 individuals was followed up after rotational atherectomy between 2012 and 2016. The most frequently observed risk factors were hypertension (87%), dyslipidemia (69%), diabetes mellitus (44%), and sedentary lifestyle (72%). A total of 244 vessels were treated, 179 of which with the aid of rotational atherectomy, and 308 drug-eluting stents were implanted. The SYNTAX II score was 22.4±11.5, with 18% of individuals classified as high risk (>33 points); femoral arterial access was employed in 76.8%. Lesion transposition was achieved in 98% of cases. Angiographic success was achieved with stenting in 98% of procedures. The length of hospital stay was 2.6±3.7 days. In-hospital mortality was 4%, and 4-year mortality was 14.5%. Long-term follow-up was performed by phone calls up to 4 years after the procedure. Ninety-seven percent of patients maintained regular use of dual antiplatelet therapy. Only 42% reported regular exercise. Angina pectoris was reported by 13% of individuals. Conclusion: Rotational atherectomy showed a low occurrence of adverse events in the immediate and late phases, leading to a high success rate of stent implantation in complex lesions.

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Pessoas com fibrilação atrial (FA) tem um risco cinco vezes maior de sofrer um AVC do que as pessoas que não sofrem esse problema. O acidente vascular cerebral secundário à FA tem sido associado a taxas de mortalidade e de incapacidade permanente elevadas, porquanto sua prevenção eficaz é importante. Métodos mecânicos para a oclusão do AAE foram desenvolvidos como alternativa à anticoagulação oral para pacientes com contraindicações ou complicações derivadas da anticoagulação. O caso é de um paciente do sexo masculino, de 86 anos, hipertenso e portador de FA que foi admitido em nosso serviço no dia 07/06/2020 com quadro de lipotimia, dispneia e dor torácica associado a bradicardia (FC de 32 bpm) e ritmo de bloqueio atrioventricular total com FA, foi internado na UTI, passado um marcapasso provisório transvenoso, suspenso o atenolol e iniciado anticoagulação plena com enoxaparina. No entanto evoluiu com quadro de melena importante no dia 12/06/2020 com queda hematimétrica e necessidade de transfusão sanguínea, sendo suspensa a anticoagulação e realizada investigação com EDA e colonoscopia. Foi submetido a ecocardiograma transesofágico e estudo eletrofisiológico para avaliar cardioversão e ablação da FA. Foram realizadas duas tentativas de cardioversão elétrica sem sucesso. Paciente recebe alta hospitalar no dia 21/06/2020 em uso de Eliquis 5mg 2x ao dia associado a clopidogrel. Porém no dia 06/07/2020 evoluiu com hematoma contido em hemitórax direito retropeitoral, foi reduzido a dose do Eliquis® para 2,5mg 2x ao dia, paciente manteve persistência de hematoma sendo então suspenso o anticoagulante e programado o fechamento de AAE.

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The widespread use of bare metal stents as from 1995 led to the appearance of a new entity called in-stent restenosis, and the severe concomitant calcification of the vessels is a challenge for the interventional cardiologist. In this scenario, rotational atherectomy has rised as a therapeutic rescue approach to manage this situation, using trephines to eliminate the underexpanded and non-expandable coronary stents. However, comprehensive data on the long-term efficacy or results of the procedures have not been published yet. We report a case of rotational atherectomy in stent restenosis, followed by percutaneous coronary intervention with implantation of a new stent to treat a calcified in-stent lesion.

Background: Significant lesions in the left main coronary artery are found in approximately 5% of patients undergoing coronary angiography, with most cases involving multiple vessels and affecting the distal bifurcation. A coronary artery bypass graft surgery is considered the preferred treatment for unprotected left main coronary artery lesions. However, with the advancement of techniques and the introduction of new drug-eluting stents, percutaneous coronary intervention has been considered a viable strategy, with favorable results. The objective of this study was to analyze the outcomes in patients with unprotected left main coronary artery lesions undergoing percutaneous coronary intervention. Methods: Electronic data from patients undergoing percutaneous coronary intervention between December 2017 and January 2020 at a single center were analyzed to assess clinical and angiographic characteristics and clinical outcomes. Results: A total of 103 patients with significant unprotected left main coronary artery lesions were included; in that, 66% were male, 88.3% were hypertensive, and 87.4% had normal ventricular function. Lesions involving the bifurcation were identified in 73.8% of patients, 36.9% had concomitant lesions in the three major epicardial vessels, and 42.7% had an intermediate SYNTAX score (23 to 32 points). Angiographic success was achieved in 100% of cases, with four (3.9%) adverse cardiac and cerebrovascular events, with 2.9% mortality. Conclusion: Hospital results support percutaneous coronary intervention as a safe procedure, with excellent angiographic results and low rates of adverse cardiac and cerebrovascular events. We concluded that PCI is an option to coronary artery bypass graft surgery and is a very viable option for surgical treatment of unprotected left main coronary artery lesions.