Dario Dilber, Igor Šesto, Janko Szavits-Nossan, Alan Jelić, Andrija Škopljanac Mačina, Krešimir Štambuk
{"title":"INTRAVASCULAR LITHOTRIPSY FOR SEVERE STENT UNDEREXPANSION.","authors":"Dario Dilber, Igor Šesto, Janko Szavits-Nossan, Alan Jelić, Andrija Škopljanac Mačina, Krešimir Štambuk","doi":"10.20471/acc.2024.63.s1.19","DOIUrl":"10.20471/acc.2024.63.s1.19","url":null,"abstract":"<p><p>Management of heavily calcified lesions during percutaneous coronary intervention (PCI) is often associated with a high incidence of complications and long-term adverse outcomes as the suboptimal coronary stent expansion due to calcified lesion is one of the strongest predictors of adverse outcomes. Shockwave intravascular lithotripsy (S-IVL) is a new technique used in the optimal debulking and preparation of severely calcified coronary artery stenoses, but there is few data on its efficacy in acute or postponed optimization of underexpanded stents. We report a case of a 66-year-old male patient with severe underlying calcification of LAD and a marked stent underexpansion after PCI of chronic total occlusion (CTO) due to a lack of adequate predilatation and postdilatation, where S-IVL was applied, resulting in excellent stent expansion. S-IVL could be considered for treating acute and late stent underexpansion caused by severe underlying calcification.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"101-104"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"TECHNIQUE CROSSOVER IN STENTING CORONARY BIFURCATION.","authors":"Sandra Šarić, Marin Vučković","doi":"10.20471/acc.2024.63.s1.7","DOIUrl":"10.20471/acc.2024.63.s1.7","url":null,"abstract":"<p><p>Planning and guiding PCI in a complex intervention is very important and one of the most important decisions is the one on whether to use one or two stent bifurcation techniques. Unfortunately, this can easily turn into complication and the need to alter the procedural strategy. The main points to be considered when deciding on the PCI strategy are related to both procedural safety and long-term outcomes. Provisional stenting has been recommended as the default technique for most coronary bifurcation lesions. In this paper, we describe the case of a patient scheduled for elective procedure of bifurcation lesion of LAD/D1. Our planned strategy was provisional stenting of LAD, using one stent for LAD, DCB for D1. Due to the complication that occurred, i.e., dissection of LAD after LAD stenting, we changed the strategy to two-stents technique strategy, using Culotte technique.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"37-42"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valentina Slivnjak, Igor Šesto, Alan Jelić, Vladimir Kalousek, Dora Cerovec, Andrija Škopljanac Mačina, Krešimir Štambuk
{"title":"TWO ACUTE STEMIS AND TWO ACUTE ISCHEMIC STROKES IN THE SAME PATIENT WITHIN FIVE DAYS - WHAT WENT WRONG?","authors":"Valentina Slivnjak, Igor Šesto, Alan Jelić, Vladimir Kalousek, Dora Cerovec, Andrija Škopljanac Mačina, Krešimir Štambuk","doi":"10.20471/acc.2024.63.s1.17","DOIUrl":"10.20471/acc.2024.63.s1.17","url":null,"abstract":"<p><p>It is not uncommon for patients to suffer from both acute myocardial infarction and acute stroke during the hospitalization. According to some studies, about 12% of the elderly population initially hospitalized for acute ischemic stroke also develop type-1 acute myocardial infarction during the same hospitalization. On the other hand, about 0.9% of patients hospitalized for acute coronary syndrome develop acute stroke during the same hospitalization1. The therapeutic approach to such \"overlapping\" patients is challenging, especially if we also take into account a high risk of bleeding and/or active bleeding. Therefore, interdisciplinary collaboration between cardiology, neurology and interventional neuroradiology is of key importance. Timely intervention and adequate concomitant drug therapy (primarily antiplatelet and anticoagulant therapy) determine treatment outcomes and long-term results. In our recent clinical work, we treated a patient with a series of acute cardiac and cerebral incidents presenting multiple therapeutic dilemmas, who ultimately had an unfavourable neurological outcome.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"90-95"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"DISTAL EMBOLIZATION OF CALCIFIED ATHEROSCLEROTIC PLAQUE FRAGMENT RESULTING IN \"BALLOON UNCROSSABLE LESION\" DURING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION.","authors":"Ivica Paulić, Joško Bulum, Mario Stipinović, Ivica Premužić Meštrović, Maro Dragičević, Tomislav Letilović","doi":"10.20471/acc.2024.63.s1.5","DOIUrl":"10.20471/acc.2024.63.s1.5","url":null,"abstract":"<p><p>Distal embolization during coronary intervention of thrombotic material resulting in compromised coronary flow is a common complication usually described in the context of invasive treatment of the acute ST-segment elevation myocardial infarction (STEMI). In our case we report distal embolization, presumably with calcified atherosclerotic plaque fragment. It occurred during elective percutaneous coronary intervention on subostial part of right coronary artery. Fortunately, this embolization did not compromise distal flow but it resulted in a significant de novo lesion of the right coronary artery crux. This lesion was uncrossable for dilatation balloons using a variety of different basic and advanced tools and techniques. Therefore, we decided to perform rotational atherectomy that enabled a successful percutaneous coronary intervention with stent implantation.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"26-29"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irzal Hadžibegović, Ivana Jurin, Tomislav Šipić, Marin Pavlov, Nikola Pavlović, Mario Udovičić
{"title":"STENT CATHETER TOO SHORT TO SOLVE A BIZZARE STENT EMBOLIZATION: WHAT TO DO?","authors":"Irzal Hadžibegović, Ivana Jurin, Tomislav Šipić, Marin Pavlov, Nikola Pavlović, Mario Udovičić","doi":"10.20471/acc.2024.63.s1.1","DOIUrl":"10.20471/acc.2024.63.s1.1","url":null,"abstract":"<p><p>Coronary stent dislodgement with migration and/or embolization is a relatively rare complication of percutaneous coronary intervention. In case of stent dislodgement or embolization in the coronary artery without the coronary wire passing through the dislodged stent, retrieval with a snare device is often the safest and the most effective procedure. We report a rare case of coronary stent dislodgement in the culprit right coronary artery, its migration and embolization in the left coronary artery, and successful retrieval with a short single-loop snare through a shortened guiding catheter.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"9-13"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Bernat, Volker Windmüller, Vasileios Leivaditis, Manfred Dahm, Burghard Schumacher
{"title":"VALVE-IN-VALVE IMPLANTATION GONE SOUTH: A CASE REPORT.","authors":"Robert Bernat, Volker Windmüller, Vasileios Leivaditis, Manfred Dahm, Burghard Schumacher","doi":"10.20471/acc.2024.63.s1.16","DOIUrl":"10.20471/acc.2024.63.s1.16","url":null,"abstract":"<p><p>Valve-in-Valve (ViV) procedures for failed surgical bioprostheses are becoming increasingly common. We present a case of a 73-year-old male patient with significant comorbidities who underwent a primary transcatheter aortic valve implantation (TAVI) with an Evolut 29 mm (Medtronic, Minneapolis, MN, USA) valve. This TAVI-prosthesis implantation failed due to the inability to fix the valve at the appropriate height to achieve an optimal hemodynamic result. The valve had to be snared and pulled into an adequate position and was then fixed by an implantation of another TAVI-prosthesis (29 mm Sapien S3, Edwards Lifesciences, Irvine, CA, USA) with optimal final result. The patient was discharged after significant clinical improvement and without further complications.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"86-89"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CASE REPORT: TO STOP ON TIME - ONE OF THE HARDEST DECISIONS: 'LOSS' OF THE STENT IN A CALCIFIED RCA.","authors":"Ivan Rosović, Damir Avdagić, Rajko Miškulin","doi":"10.20471/acc.2024.63.s1.22","DOIUrl":"10.20471/acc.2024.63.s1.22","url":null,"abstract":"<p><p>A case report of a 63-year-old man who was indicated for invasive coronarography during outpatient treatment. The completed coronarography confirmed a significant stenosis in the highly calcified right coronary artery (RCA). In order to determine the hemodynamic significance of the borderline significant stenosis of the curved branch of the left coronary artery, FFR was performed. Despite the use of non-compliance balloons and high-pressure OPN balloons during elective PCI-RCA, the lesion in question could not be predilated, resulting in the need for the patient to undergo PCI-RCA with rotablation. During the repeated PCI-RCA procedure, the proximal and middle segments were subjected to rotablation. Non-compliant balloon catheters were used to perform a successful predilatation of the middle segment lesion and to try to place a stent in the designated lesion. Due to the calcified curve of the proximal segment, the stent was unable to pass through while being retracted into the leading catheter, causing it to fall into the proximal segment. The stent balloon was used to push the stent and insert it into the curve between the proximal and middle segment. A small balloon catheter (1.2 x 15 mm) successfully passed through the unexpanded stent. After subsequent inflating of the small balloon catheter and further inflating of larger balloons the lost stent was fully expanded and implanted with optimal control coronarography findings.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"116-120"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vito Mustapić, Mladen Predrijevac, Dario Dilber, Luka Rotkvić, Andrija Škopljanac Mačina, Igor Šesto, Krešimir Štambuk
{"title":"ACUTE ST ELEVATION MYOCARDIAL INFARCTION FOLLOWING BYPASS GRAFT SURGERY: A CASE OF CORONARY SUBCLAVIAN STEAL SYNDROME (CSSS) SUCCESSFULLY TREATED WITH PERCUTANEOUS INTERVENTION.","authors":"Vito Mustapić, Mladen Predrijevac, Dario Dilber, Luka Rotkvić, Andrija Škopljanac Mačina, Igor Šesto, Krešimir Štambuk","doi":"10.20471/acc.2024.63.s1.18","DOIUrl":"10.20471/acc.2024.63.s1.18","url":null,"abstract":"<p><p>Coronary subclavian steal syndrome (CSSS) is an uncommon complication of coronary artery bypass graft (CABG) surgery when the left internal mammary artery (LIMA) is used in patients with underdiagnosed significant left subclavian artery stenosis (SAS). It is characterized by a retrograde blood flow from coronary to subclavian circulation through LIMA graft, causing the \"steal\" phenomenon and myocardial ischemia. The common presentation is stable angina years after surgery and acute presentation with ST elevation early after surgery is extremely rare. Here we present an unusual and unique presentation of CSSS in a setting of acute ST elevation myocardial infarction treated successfully with complex percutaneous intervention.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"96-100"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maro Dragičević, Ivica Premužić Meštrović, Matija Marković, Mario Stipinović, Ena Kurtić, Ivica Paulić, Tomislav Letilović
{"title":"SUCCESSFUL PERCUTANEOUS CORONARY INTERVENTION OF THE TARGET LESION WITH THE LOST STENT.","authors":"Maro Dragičević, Ivica Premužić Meštrović, Matija Marković, Mario Stipinović, Ena Kurtić, Ivica Paulić, Tomislav Letilović","doi":"10.20471/acc.2024.63.s1.4","DOIUrl":"10.20471/acc.2024.63.s1.4","url":null,"abstract":"<p><p>The loss of a stent during percutaneous coronary intervention (PCI) is a rare complication of the procedure. Multiple manoeuvres for the stent extraction exist, using a small balloon being a common one (2). This case report demonstrates the loss of stent in the proximal segment of the RCA whose extraction attempt with a small size SCB failed. The SCB was unable to cross through the stent and kept pushing the stent distally up until the target location where it successfully crossed through the stent. Subsequent dilatation with larger size balloons achieved full stent expansion at the target location.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"23-25"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alan Jelić, Mladen Predrijevac, Luka Rotkvić, Valentina Slivnjak, Igor Šesto, Janko Szavits Nossan, Andrija Škopljanac Mačina, Krešimir Štambuk
{"title":"TAVI PATIENT WITH RCA DISSECTION, POST-TAVR HIGH DEGREE AV BLOCK AND ACUTE NEUROLOGICAL INJURY.","authors":"Alan Jelić, Mladen Predrijevac, Luka Rotkvić, Valentina Slivnjak, Igor Šesto, Janko Szavits Nossan, Andrija Škopljanac Mačina, Krešimir Štambuk","doi":"10.20471/acc.2024.63.s1.21","DOIUrl":"10.20471/acc.2024.63.s1.21","url":null,"abstract":"<p><p>TAVI (Transcatheter Aortic Valve Implantation) is a minimally invasive procedure for the treatment of severe aortic stenosis (AS) in elderly and comorbid patients. Following the guidelines of eminent cardiac societies, a decision on the treatment modality is made by the so-called \"heart team\". Despite being less invasive, the procedure is related to some complications, among which the most common ones are stroke, life-threatening bleeding, vascular injury, kidney injury, conduction disturbances demanding permanent pacemaker (PPM) implantation, and perivalvular leak (PVL). Here we present a case report of multiple periprocedural complications in the same patient, related to TAVI, such as right coronary artery (RCA) dissection on preoperative coronary angiography (CA), postprocedural acute neurologic injury and high grade atrioventricular (AV) block followed by PPM implantation.</p>","PeriodicalId":7072,"journal":{"name":"Acta clinica Croatica","volume":"63 Suppl1","pages":"111-115"},"PeriodicalIF":0.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}