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Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.

Despite the fact that the drug-eluting stents (DES) have markedly reduced neointimal proliferation, restenosis is still an open subject. Although DES fracture is very rare, it has been considered as one of the reasons for DES restenosis, however, the mechanism and proper management are not clearly elucidated yet. We describe two cases of sirolimus-eluting stent fracture combined with significant restenosis and suggest the possible revascularization strategies for successful management.

Sudden stent loss after stent entrapment in a tight coronary lesion is an unexpected and devastating complication. Proper and timely steps without pressing the panic button are necessary. We describe a case of entrapment of a sirolimus-eluting stent into the left coronary artery system. Although the entrapped drug-eluting stent was successfully removed using a snare device, excessive guide manipulation under this life-threatening condition led to extensive left main and left circumflex artery dissection. This was immediately rescued by direct stenting to the left main and circumflex arteries. The usage of snare device in this bail-out situation was successful, safe and prevented emergency bypass surgery.

A 20-year-old male who had fallen from the third floor of a building after excessive alcohol intake presented to our emergency room. He complained of flank pain, and subsequent simple x-ray and pelvis computed tomography revealed a right acetabular fracture, which we decided to treat conservatively. There were no other major injuries. An abdominal computed tomography scan (Figure 1A and 1B) revealed bilateral multifocal renal infarction. An urgent technetium-labeled dimercaptosuccinic acid renal scan (Figure 1C and 1D) showed significantly reduced perfusion in both lower lobes of the kidney. An emergent renal angiogram showed normal right main renal artery (Figure 2A). The anomalous right inferior polar artery showed complete thrombotic occlusion (Figure 2B). We prudently pursued the percutaneous renal intervention because there were no …

With the introduction of the drug-eluting stent (DES), re-stenosis rates have been reduced. In saphenous vein graft or ectatic coronary artery disease due to large vessel diameter their use is precluded. We report a challenging case of implantation of two sirolimus-eluting stents (SES; Cypher; Cordis) parallel to each other in an ectatic vessel. A coronary angiogram (CAG) and intravascular ultrasound (IVUS) examination carried out …

Background and Objectives： Smoking has been known to be an independent risk factor of the coronary morbidity induced by coronary artery endothelial dysfunction, but its detailed impact, including the duration and amount of smoking on coronary artery spasm, has not been clarified yet. We investigated the incidence of acetylcholine (Ach)-induced coronary artery spasm according to smoking and the smoking-related parameters. Subjects and Methods：The study consisted of 306 patients (163 males, age: 56.1±11.2 years), without significant coronary artery disease underwent Ach provocation testing by injecting incremental doses of 20, 50 and 100 ug Ach into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>75%) with/without chest pain or ST-T change of the EKG. The impact of conventional risk factors, including smoking and the smoking-related parameters, on coronary artery spasm was analyzed. Results：The conventional risk factors of coronary atherosclerosis, including hypertension, DM and hyperlipidemia, were numerically higher in the provocation (+) group, but the differences were not statistically different between the two groups. Only smoking itself was significantly higher in the provocation (+) group whereas the smoking duration, amount and the duration of quitting smoking were not different between the two groups. Conclusion： Smoking is known to be an independent risk factor of coronary artery spasm, but smoking-related parameters such as the smoking duration, the amount and the duration of quitting smoking were not associated with coronary artery spasm. (Korean Circulation J 2006;36:661-665)