Subtotal occlusion of the right coronary artery by Cardioband and its successful intervention via retrograde approach. Interventional flashlight.

In recent years, transcatheter approaches have changed the therapy of valvular regurgitation. One of these new techniques is the Cardioband ® tricuspid valve reconstruction system (Edwards Lifesciences Corp., Irvine, CA, USA), which allows an adjustment of the ring size but may cause a temporary deformation or even occlusion of the right coronary artery (RCA) due to its close proximity. We report on a patient with symptomatic and subtotal occlusion of the RCA after Cardioband implantation. The distortion was so sharp-cornered that antegrade re-canalizations failed. Finally, the subtotal occlusion was re-opened via retrograde approach and this stent remained open in long-term follow-up. We think this complication should be known and considered when using the Cardioband system. Learning objective: Transcatheter reconstruction of the tricuspid valve by Cardioband ® can lead to subtotal occlusion of the right coronary artery, which is difficult to re-canalize.

Near fatal stent thrombosis in an aneurysmatic RCX as first manifestation of heparin induced thrombocytopenia (HIT) without thrombocytopenia.

BACKGROUND: Thrombosis resulting from heparin-induced thrombocytopenia (HIT) occurs in about 2% of patients without a significant decrease in platelet counts. We report on such a near fatal thrombotic event caused by coronary intervention. CASE PRESENTATION: A supposedly "completely healthy" 53-year-old patient was admitted to hospital with covered rupture of an aneurysm of the Aorta descendens. He was successfully operated on and underwent coronary angiography due to NSTEMI six days later. Immediately after intervention of a 90% RCX stenosis he developed ventricular flutter, was defibrillated, and re-angiography showed partial occlusion of the RCX stent. Lots of white thrombi could be retrieved by aspiration catheter and gave reason for a HIT without thrombocytopenia. The detection of platelet factor 4/heparin complex antibodies by immunoassay supported and the subsequent Heparin Induced Platelet Activation Assay proved this diagnosis. CONCLUSIONS: The clinical event of an acute stent thrombosis should alarm the interventional team to the diagnosis of HIT even with a normal platelet count.