In recent times the outcome of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in dedicated centers has steadily gained high success rate (> 80%) and low rate of coronary complications. Nevertheless comparing with non-CTO PCI the complications rate is higher, due to the higher lesion and technical complexity. Among the complications Type III coronary perforations remain the most troublesome events of CTO PCI and still carry a significant risk of death for the patients. The management of Type III coronary perforations has been extensively described as a flow chart of interventions and techniques to obtain rapid cessation of the blood extravasation and sealing of the ruptured vessel. Several techniques have been described to obtain bleeding cessation also in small vessel (< 2 mm) perforations.In this paper we will describe two cases of CTO PCI with Type III small vessel coronary perforations treated with percutaneous Cyanoacrylate/(NBCA-MS)-based glue infusion through a conventional CTO microcatheter. This technique is fast and straightforward and can be applied to any conventional CTO microcatheter.
Poster Display I. Cardiomyopathy 39 patients (58%), which presented normal coronary arteries at angiography. RvD involved 51 out of 646 segments (7.9%) with a mean defect area of 9.5±10% of the LV surface. Among the 51 segments with RvD in the previous study, 35 (68%) evolved to present ReD in the current study, while only 8.6% o the segments without RvD exhibited the same evolution, p<0.0001, Fisher Exact test. Conclusions: In CC patients the progression of global and segmental LV systolic dysfunction was associated to both the increase in perfusion defects at rest and to the presence of reversible perfusion defects. These results support the notion that myocardial perfusion disturbances participate in the pathogenesis of myocardial injury in CC.
The acronym MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) refers to myocardial infarction with normal or near-normal coronary arteries on invasive angiography. The broad spectrum of pathological mechanisms responsible for myocardial injury in MINOCA makes defining the exact underlying etiology challenging. We report the uncommon case of an acute myocardial infarction with normal coronary arteries suggestive of MINOCA caused by paradoxical coronary embolism due to a wide right-to-left shunting through a patent fossa ovalis. Integrated multimodality imaging diagnostic work-up, including cardiac magnetic resonance, transesophageal contrast echocardiography, and transcranial contrast Doppler, has been crucial for identifying the most likely mechanism underlying MINOCA.
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