Chronic total occlusions of the superficial femoral artery occur in approximately 40% of patients with symptomatic peripheral arterial disease. When antegrade revascularization fails or is not feasible, a retrograde approach should be considered. This is usually via the popliteal or tibial vessels. Alternatively, transcollateral revascularization has been reported. This report describes the use of transcollateral retrograde revascularization of the superficial femoral artery in two patients with failed antegrade crossing. Retrograde recanalization was achieved via a branch of the profunda femoris artery. Unlike previous reports that describe retrograde crossing and subsequent snaring of the wire, these cases were performed with retrograde passage of a low-profile balloon. Following retrograde balloon dilation, the vessel was rewired from an antegrade approach and the procedure was completed with complications.

Coronary pseudoaneurysm after bare-metal stent implantation is a rare event. Observation, surgical resection, or implantation of another stent, bare or covered, are alternative and equivalent management options. Since no option prevails over the other, the most appropriate treatment should be evaluated in every single patient. We report the case of a pseudoaneurysm within a stent with diffuse restenosis, treated with implantation of a pericardium-covered stent, followed by postdilation with a paclitaxel-eluting balloon.

Transcatheter closure of a patent ductus arteriosus (PDA) is a well-established technique that may occasionally be complicated by severe thrombocytopenia. We report herein 6 cases of PDA in which circulating platelet counts were notably reduced within 18-48 hours following the procedure. A number of interventions, including blood-pressure control, protection against hemorrhage, and eradication of residual flow, were performed. Platelet counts in all patients were restored to preprocedural levels through intravenous infusion of dexamethasone and human gamma globulin.

We report the innovation of both a partly-covered and completely-covered, variable-diameter, balloon-expandable stent that was custom-designed by NuMed, Inc for percutaneous closure of a baffle leak after total caval pulmonary connection (TCPC). A 50-year-old patient, born with tricuspid atresia, who had undergone TCPC, developed severe persistent cyanosis due to a right-to-left shunt through a TCPC baffle leak. Re-operation was deemed too high risk. Therefore, considering his complex anatomy, a custom-made, partly-covered, tapered, balloon-expandable stent was designed and successfully deployed. Months later, the shunt recurred at the junction of the covered to uncovered stent cells; subsequently, a second fully-covered, custom-made, tapered stent was implanted with an excellent outcome. The use of covered or partly-covered customized variablediameter stents for closure of baffle leak after TCPC is feasible and resulted in marked clinical improvement. Customized balloon-expandable stents may be superior to traditional cylindrical stents because of better anchoring and apposition.

With the advent of transcatheter aortic valve implantation (TAVI), many AS patients, formerly considered inoperable, can receive effective treatment. The relief of the left ventricular pressure overload could lead, in some cases, to the occurrence of dynamic intracavity pressure gradients (DIG) with deleterious clinical impact. This phenomenon resembles the physiology seen in hypertrophic obstructive cardiomyopathy. We report a case in which alcohol septal ablation was used as a bail-out therapy for the acutely developed intracavity obstruction after TAVI. Potential dynamic intracavity gradients should always be excluded in the acutely deteriorated patient postoperatively. Alcohol septal ablation can be considered as a salvage therapeutic tool when other therapies are ineffective to treat subvalvular obstruction.

Attempted atrial transseptal puncture in a 63-year-old man undergoing an ablative procedure for atrial fibrillation was complicated by inadvertent delivery of an 8 Fr sheath across the aorta. Due to obesity-related perioperative risks, we opted for percutaneous repair rather than open-heart corrective surgery. Our case is unique for the novel percutaneous delivery of an Amplatzer atrial septal defect (ASD) closure device to the defect in the non-coronary aortic cusp through an 8 Fr left atrial multipurpose sheath not designed for this purpose. At 9-month follow-up, he had a mild residual internuclear ophthalmoplegia.

We present a case of symptomatic carotid artery thrombosis treated with catheter intervention under proximal occlusion and flow reversal embolic protection. Although catheter intervention is contraindicated in carotid artery thrombosis due to the risk of distal embolization, the introduction of proximal occlusion embolic protection devices allow interventionalists to use catheter intervention where it was previously deemed too high a risk. A Gore Flow Reversal device was used in a 57-year-old male with obesity, uncontrolled type I diabetes mellitus, hypertension, hyperlipidemia, and prior stroke who had previously undergone left internal carotid artery revascularization with carotid artery endarterectomy and patch angioplasty. Since balloon disruption and manual aspiration through the balloon sheath of the flow reversal device was unable to remove the thrombosis, an AngioJet 4 Fr RX catheter was used to mechanically remove material via mechanical thrombectomy. As there was still residual stenosis, a stent was placed in the area to decrease the remaining blockage. Follow-up carotid artery duplex scanning showed that the procedure eliminated the carotid occlusion. The embolic protection device and the procedural technical aspects are described herein, as are reports of both clinical and anatomical follow-up. We show that by using a Gore Flow Reversal protection device, we were able to use catheter therapy to treat a carotid thrombosis, which was previously contraindicated for this condition.

Longitudinal deformation of coronary stents has been recently described and seems to be more frequent with certain contemporary stent platforms. Indeed, in order to increase flexibility and deliverability, stent manufacturers have reduced strut thickness and the number of connectors within cells; this could negatively affect other mechanical properties of the device, such as the resistance to longitudinal stress. Moreover, longitudinal deformation has been associated to adverse events, such as stent thrombosis.We report 3 cases of longitudinal stent deformation observed at our institution.The first case was a consequence of postdilatation of the stent with a non-compliant balloon, whereas the other 2 cases involved the treatment of bifurcation lesions. One case was complicated by acute, intraprocedural stent thrombosis; such a dreadful complication, to the best of our knowledge, has not been previously reported.Although longitudinal stent deformation is an infrequent finding, usually not associated with adverse events, at least in the short term, it can sometimes turn into a catastrophic, life-threatening complication. The growing number of reports about this issue in recent years should prompt the operators to carefully select coronary stents, especially when dealing with certain lesion subsets, such as ostial lesions, bifurcations, and long lesions.

The surgical and transcatheter coil closure of coronary arterial fistulas are described in the literature. We report our experience with the successful transcatheter closure of a coronary arterial fistula, arising from the left coronary artery and draining into the right ventricle, with the new Amplatzer duct occluder II device.

Atrial septal defect (ASD) is one of the most common congenital heart defects, accounting for 7%-10% of all congenital heart disease (CHD) in children and 30%-33% of defects diagnosed in adults with CHD. This review highlights the evolution of transcatheter ASD closure, indications, follow-up, outcomes, and complications with a focus on the erosion issue with certain devices.