1.
Coronary stenting in patients with medically resistant vasospasm.
Khitri, A, Jayasuriya, S, Habibzadeh, MR, Movahed, MR
Reviews in cardiovascular medicine. 2010;(4):264-70
Abstract
Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfully treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm.
2.
[Cholesterol-crystal embolization after PTCA. Case report and review of the literature].
Gerke, R, Fahrenkrog, U, Löllgen, H
Medizinische Klinik (Munich, Germany : 1983). 2003;(7):388-93
Abstract
HISTORY A 62-year-old male patient with depression after coronary intervention (PTCA) 4 weeks earlier. THERAPY AND CLINICAL COURSE The patient developed insufficiency of liver and kidney as well as painful toe lesions. Some more symptoms were observed such as recurrent pulmonary edema, arterial hypertension, hardly responding to medical therapy, and severe gastrointestinal symptoms. The variety of symptoms and the progress of the disease were similar to a generalized vasculitis. Renal biopsy yielded the diagnosis of cholesterol-crystal embolization (CCE). After short-term remission, the patient died following prolonged and severe progression of the disease. CONCLUSION CCE is a rare disease with devastating outcome. Clinicians should be aware of the disease, especially with regard to an increasing number of coronary interventions in older patients.
3.
Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.
Izumi, AK, Samlaska, CP, Hew, DW, Bruno, PP
Cutis. 2000;(6):447-52
Abstract
Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and Staphylococcus aureus septicemia. Culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.