Fatal derecruitment of occluded left anterior descending collaterals after left circumflex revascularization

Coronary arteries are not definitely functionally terminal arteries, as previously thought; indeed, they are linked and interconnected by a rich network of collaterals. Chronic total occlusions [CTOs] represent a subset of frequent lesions encountered in everyday catheterization laboratory practice, generally associated with a developed system of collateral connections. These latter have the capacity to prevent myocardial necrosis and may even uphold metabolic supply to the ischemic territory to maintain its contractile capacity. Authors have reported a rapid and progressive reduction of collateral function and their decline after antegrade flow restoration, resulting in higher myocardial susceptibility to ischemia in the CTO territory. Here, we report the case of a fatal derecruitment of collaterals for a left anterior descending CTO not reopened, after left circumflex subocclusion revascularization

Guideliner Catheter: a useful tool in the armamentarium of the interventional cardiologist

Regardless of the clinical setting, a good back-up represents one of the most important conditions to ensure guide wire and balloon advancement and stent delivery. As a "mother and child" system, the GuideLiner catheter [Vascular Solutions Inc., Minneapolis, MN, USA] provides an extension to the guide catheter with better coaxial alignment and stability. We report two didactic cases showing the usefulness of the GuideLiner device in everyday catheterization laboratory practice. The first case was a primary percutaneous coronary intervention [PCI] in a 71-year-old diabetic man admitted for inferior STelevation myocardial infarction, related to tight proximal stenosis in a dominant tortuous and calcified left circumflex. The second case was an elective PCI in a 76-year-old man admitted for stable angina [Canadian Cardiovascular Society [CCS] class III], related to focal intra-stent restenosis of a saphenous venous graft to the left anterior descending. In both cases, the GuideLiner catheter provided a good back-up insuring the success of PCI and drug-eluting stents implantation, with a good in-hospital outcome

Mechanical post-conditioning in STEMI patients undergoing primary percutaneous coronary intervention

Although early myocardial reperfusion via primary percutaneous coronary intervention [PCI] allows the preservation of left ventricular function and improves outcome, the acute restoration of blood flow may contribute to the pathophysiology of infarction, a complex phenomenon called reperfusion injury. First described in animal models of coronary obstruction, mechanical post-conditioning, a sequence of repetitive interruption of coronary blood flow applied immediately after reopening of the occluded vessel, was able to reduce the infarct size. However, evidence of its real benefit remains controversial. This review describes the mechanisms of post-conditioning action and the different protocols employed focusing on its impact on primary PCI outcome

innovation of composite core dual coil coronary guide-wire technology: a didactic coronary chronic total occlusion revascularization case report

The treatment of coronary chronic total occlusions [CTO] continues to solicit technical innovations. As success primarily depends on crossing the lesion with a wire, all aspects regarding tip shape retention, torque precision, and penetration ability of the guide-wire have greatly influenced new techniques and strategies. The world of interventional cardiology has to look carefully at these developments, and to use them accordingly to improve the success rate in ordinary percutaneous coronary interventions. We present a didactical case report of a CTO revascularization treated with a new 'dual core' technology guide-wire