[Percutaneous transluminal angioplasty using Filtrap to capture thrombus for chronic total occlusion of superficial femoral artery: a case report].

A 75-year-old female was admitted for cerebral infarction and arteriosclerosis obliterans. Computed tomography with contrast medium revealed occlusion of the superficial femoral artery (SFA). Percutaneous transluminal angioplasty (PTA)was performed for the SFA (length 30 cm), but massive thrombus was seen in the SFA. PTA was continued using a Filtrap deployed at the popliteal artery to prevent distal embolism and the thrombus was captured by the Filtrap. Finally antegrade blood flow was observed. However, the following day, acute stent thrombosis occurred and emergent PTA was performed. Suboptimal stent expansion and dissection were found. Balloon angioplasty was performed using a Filtrap and another stent was deployed. Final angiography revealed good blood flow in the SFA. Filtrap may reduce the risk of distal embolism during PTA for the lower limb.

Usefulness of late gadolinium enhancement combined with MRI and 67-Ga scintigraphy in the diagnosis of cardiac sarcoidosis and disease activity evaluation.

We report a case in which late gadolinium enhancement (LGE) and 67-Ga scintigraphy were useful for the diagnosis of cardiac sarcoidosis and for the evaluation of the disease activity. The patient was a 60-year-old woman who had been diagnosed as having eye sarcoidosis when she was 48. Two years previously her electrocardiogram had shown abnormalities but the coronary angiography had shown normal coronary arteries; however, an aneurysm was detected in the apical portion by left ventriculography. A II degree AV block was noted on the electrocardiogram and she was referred to us for further detailed evaluation. Since the biopsy findings of skin eruptions on both eyelids indicated an epithelial cell granuloma, she was diagnosed as having cutaneous sarcoidosis. On the 67-Ga scintigram, myocardial accumulation of gallium was recognized, and on cardiovascular magnetic resonance (CMR), LGE was recognized. She was diagnosed as cardiac sarcoidosis and steroid therapy started with 30 mg prednisolone. The myocardial accumulation of gallium on the 67-Ga scintigram disappeared after the 30th day of steroid therapy. On the other hand, no changes in LGE patterns were seen after steroid therapy. In this case, LGE was useful for the diagnosis of cardiac sarcoidosis, and 67-Ga scintigram was useful for the evaluation of the disease activity. This case shows that both imaging techniques are important for the diagnosis of cardiac sarcoidosis and evaluation of the disease.

[Assessment of the time course of stunned myocardium with cardiac magnetic resonance imaging: a case report].

A 77-year-old woman with chest pain was admitted to our hospital for evaluation and treatment. Electrocardiography showed T-wave inversion in the I, aVL and V2-V6 leads. Emergency coronary angiography showed 75% stenosis in the left anterior descending artery. Left ventriculography demonstrated akinesis of the left ventricular apical region. Iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid radioactive isotope imaging showed an uptake defect in the apical region during the acute phase, but the defect disappeared 1 month later. Cine cardiac magnetic resonance (CMR) in the acute phase showed apical akinesis and hyperkinesis of the mid region, as observed by left ventriculography. Contrast magnetic resonance imaging with gadolinium showed no delayed hyperenhancement. One month later, cine CMR showed disappearance of the abnormal wall motion and contrast magnetic resonance imaging demonstrated no delayed hyperenhancement. CMR is useful to monitor changes in wall motion and wall thickening in the stunned myocardium.