Percutaneous non-stenting approach for distal simultaneous multivessel acute coronary occlusions

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein [GP] IIb/IIIa inhibitor and Factor X inhibitor [Rivaroxaban] with full resolution of flow in the distal vessels. Thus, coronary lesions, not amenable to stenting, can be dealt percutaneously, using a combination of old and newer pharmacological agents without stenting

multiparous woman with lately diagnosed multilevel left ventricular obstruction

A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society [CCS] class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography [TTE] revealed moderate aortic stenosis [AS] and mid cavity left ventricular outflow [LVO] obstruction. Left heart catheterization [LHC] showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well

"Mother and child technique" combined with super selective pharmacological intervention for large intracoronary thrombus

Primary percutaneous intervention [PCI] in acute ST elevation myocardial infarction [MI] is a preferred way of treatment nowadays. Sometimes it becomes difficult to get good myocardial blood flow during PCI if clot burden is large. In this case of an elderly lady, the use of "Mother and Child Technique" combined with super selective pharmacological intervention is demonstrated to achieve good blood flow when conventional means are not working