Dr. Anil Krishna Gundala

Description:Stent under expansion is one of the reasons compromising the outcomes of percutaneous coronary interventions. The most common cause of the stent under expansion is calcium deposited in the atherosclerotic plaque. Adequate plaque modification is the paramount before the placement of a stent, as the options to handle under expanded stent are limited and less effective. In this case report, we explore the usage of knuckle wire for the extrastent plaque modification, after being failed with routine methods of handling stent under expansion.

Description:Calcific coronary artery disease presents a major challenge for percutaneous coronary intervention as it can be associated with stent delivery failure and suboptimal stent expansion. Currently, numerous therapeutic options are available for modifying calcific coronary plaques, and also coronary imaging to assess adequacy of plaque modification. Mechanical debulking with rotational atherectomy is the time trusted plaque modification strategies for heavily calcified and recalcitrant coronary lesions prior to stenting. We report a rare case with calcified tandem right coronary artery lesions in which sequential rotablation done using guide catheter extension to facilitate delivery of rotational atherectomy burr to distal lesion enabling successful percutaneous coronary interventions.

Description:Iatrogenic ascending aortic pseudoaneurysms are a rare but life-threatening complication of reconstructive cardiovascular surgery. Such aneurysms can result in rupture, thrombosis, or distal embolization. Surgical repair of such pseudoaneurysms is associated with high morbidity and mortality. We present a rare case of device closure of saccular pseudoaneurysm of the ascending aorta in a patient with valve-sparing Bentall surgery for acute type A aortic dissection. Pseudoaneurysms represent a collection of blood between the adventitia and media resulting from a disruption in the aortic wall. Iatrogenic ascending aortic pseudoaneurysms are a rare but life-threatening complication of reconstructive cardiac surgery. They can occur at the cannulation site, clamping site, or graft anastomosis site.1 Such aneurysms are predisposed to rupture, thrombosis, and distal embolization. Open surgical repair is considered standard of care but can be difficult and has substantial morbidity and mortality reaching up to 21% in specific patients.2 If preprocedural imaging demonstrates suitable anatomy, direct transcatheter closure with a device offers a minimally invasive approach which obviates the need of landing zones for a stent graft. In this report, we describe successful transcatheter closure of technically challenging case of ascending aortic pseudoaneurysm with a Konar MF ventricular septal defect closure device. To our knowledge, this is the first such case where Konar MF device is used for pseudoaneurysm closure.