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Chronic refractory angina pectoris (AP) affects 600,000 to 1,800,000 Americans, with approximately 50,000 new cases annually. A recent study revealed long-term mortality of refractory AP to be lower than previously reported, with >70% of patients living >9 years. Treating AP can improve quality of life. We describe a patient with refractory AP who underwent a successful stellate ganglion block for symptom control.

Rotational atherectomy (RA) utilizes a high-speed diamond grinding wheel to remove the calcified atherosclerotic plaque off the vessel wall via a catheter inside an artery for blood flow restoration and treatment of cardiovascular diseases. RA in angulated lesions is challenging due to the geometric constrains on the wheel motion, potentially leading to vessel dissection and perforation. To understand the grinding wheel motion and force during RA in curved arteries, experiments were conducted based on 3D printed anatomically accurate coronary artery phantoms with plaster coating as the plaque surrogate, a high-speed camera, and a multi-axis force transducer. Results showed that the grinding wheel did not orbit inside right coronary artery phantom which led to a highly biased ground region aligned with several contact points between the guidewire and the arterial wall. The grinding wheel orbital motion facilitated an even treatment of several segments in left anterior descending coronary artery phantom. The grinding force, ranging from 0.05 to 0.20 N, increased with the wheel rotational speed when the wheel orbited and was insensitive to the wheel speed without wheel orbital motion. This study explained the clinically observed guidewire bias from the engineering perspective and further revealed the RA mechanism of action in angulated artery, which may assist to improve the device design and the operating technique.

(13.6%) were found to have AKI in which 2 (66.7%) were in AKIN I and 1 (33.3%) was in AKIN 3. Dialysis support was initiated for the patient with AKIN 3. The AKI group had higher level of serum creatinine on admission which was 268.3 umol/L (134.9) as compared to non-AKI group of 141.4 umol/L (91.3) (p ¼ 0.047). There was no significant association between occurrence of AKI and patients' age, gender, comorbidities (i.e. diabetes mellitus, hypertension and stroke), previous usage of medications (i.e. ACEi/ARB or diuretics), and level of haemoglobin or albumin. Conclusion: The incidence of AKI in patients presented with ACS in our study is low. Further data from the continuation of this study will clarify AKI incidence in ACS and its associated outcomes better.

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