Radial artery pseudoaneurysm (RAP) at the site of transradial access (TRA) for coronary angiography is rare. A clean puncture, secure bandage, and watchful follow‐up are must to prevent complete occlusion and aneurysm formation at the access site. This illustration describes surgical repair as one of the successful strategies to repair a postcatheterization RAP after TRA.

Left main coronary artery dissection induced by the tip of the guide catheter (Razor blade effect) with or without extension into the adjacent aortic wall can result in no flow. It is being a life threatening, complication and must be time timely detected and treated by stenting or surgery. A 59-year-old male patient presented with crescendo angina having a history of stenting to left anterior descending coronary artery (LAD) using 3 mm × 23 mm drug-eluting stent 5 years back. Coronary angiogram revealed 100% instent re-stenosis of the LAD. Left circumflex (LCX) coronary artery had proximal chronic total occlusion with J-CTO score of ≥2. The dominant right coronary artery was normal. LMCA dissection was noticed like an invisible dragon from nowhere after stenting of the proximal LCX followed by abrupt retrograde extension into aorta, resulting in no flow in the left coronary artery. The true lumen of LMCA was re-wired, and timely bailout stenting from LMCA to LCX was performed.

A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had higher refractory period than atrioventricular node.

BACKGROUND Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Delayed presentation, cyanosis and effort intolerance are some of the important features. The diagnosis is confirmed by computed tomography or pulmonary artery angiography. Catheter-based closure is preferred to surgery. CASE SUMMARY Left pulmonary artery-to-left atrial fistula is rare. A 40-year-old male presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug. CONCLUSION Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.

Among the complex and high-risk coronary intervention cases, a calcified total occlusion of coronary artery poses a great challenge. We came across a 48 years old male who had calcified total occlusion of the right coronary artery. The chronic total occlusion was crossed using Nic-Nano balloon and the calcific plaque was modified using intravascular lithotripsy as an alternative technique to rotational atherectomy which we felt as an evolving alternative approach to treat the calcified total occlusion.