Not So Stable Angina: Single Coronary Artery Disease.

A single coronary artery (SCA) is a rare congenital anomaly that can be incidentally found as a part of ischemic heart disease or angina workup. A modified Lipton classification is used to categorize the disease. The majority of diseases do not need surgical correction, with the exception of a few conditions. This report presented the case of a 49-year-old man who presented with stable angina with a single coronary artery arising from the right coronary sinus with an intraseptal course of the left main coronary artery. This is categorized as RII-S in the modified Lipton classification and is considered a high-risk anomaly. He underwent an unroofing procedure to decompress the left coronary artery with a resolution of symptoms.

Use of Shockwave Lithoplasty for a Patient With Recurrent Angina.

Current calcium modification treatments only address the burden of intimal calcium with varying degrees of success and result in an increased risk for adverse events. Here, we describe the use of shockwave intravascular lithoplasty (S-IVL) to effectively treat a severely calcified coronary artery lesion. A 59-year-old male with a history of coronary artery disease with stents presented to our hospital with angina. Diagnostic coronary angiography revealed a mid-right coronary artery (mRCA) stent with severe in-stent restenosis due to under expansion of stent with severe calcification. Due to these factors, the decision was made to reduce the calcium burden with the use of S-IVL. This is a promising technique in plaque modification of severely calcified coronary lesions with less risk of myocardial injury and mechanical vascular trauma. It is important to customize the choice of therapy based on the patient and the characteristics of the coronary lesion.

Percutaneous Intervention of Iatrogenic Iliac Artery Vascular Complication.

The mortality of patients from a retroperitoneal hematoma remains high if treatment is delayed or inappropriate. Percutaneous endovascular repair of iatrogenic vascular complications is quickly becoming the treatment of choice. Here, we report a case of a 76-year-old female with a non-ST-elevation myocardial infarction, whose cardiac catheterization revealed a 70% distal left main coronary artery (LMCA) stenosis. She underwent successful rotational atherectomy and deployment of drug-eluting stents of the distal LMCA. Following percutaneous coronary intervention, she suffered acute profound hypotension and was found to have a retroperitoneal hematoma. Given the high cardiac risk for vascular surgery due to recent intervention and overall comorbidities, she was immediately taken to the cardiac catheterization laboratory and had a diagnostic angiogram, which revealed a right external iliac artery perforation that was treated with a covered stent. She tolerated the procedure well. This case highlights the importance of early diagnosis of retroperitoneal bleed, the prompt decision to take the patient to the cardiac catheterization laboratory, and potential use of intravascular interventions to ensure a successful outcome.