We describe 2 patients with Takayasu's arteritis and left main coronary stenosis who were considered poor candidates for surgical revascularization. Elective left main coronary artery balloon angioplasty followed by endoluminal stenting was performed with excellent results. At 3-mo follow-up, one patient had evidence of in-stent restenosis, but the other remained asymptomatic. In selected patients with Takayasu's arteritis and left main coronary stenosis, elective endoluminal stenting can be used as a definitive procedure or as a bridge to surgical revascularization.

Despite the advancements in the pharmacological and mechanical treatment of acute coronary syndromes, intracoronary thrombus and distal embolization remain among the major limitations of percutaneous transluminal coronary interventions. We describe three cases in which intragraft or intracoronary thrombus was completely aspirated during PTCI using the guiding catheter. In the first case, a 4-cm-long unfragmented embolized thrombus was effectively and completely aspirated from a saphenous vein graft, with immediate restoration of normal flow. In the second case, multiple fragments of embolized thrombus were aspirated from a large right coronary artery, while in the third case, intragraft thrombus was electively aspirated. In each case, the index lesions were then successfully stented without complications.

A novel, transhepatic approach to mitral valvuloplasty is described in a patient with an inferior vena caval filter. After transhepatic transseptal puncture, an lnoue dilatation catheter was passed through the hepatic parenchyma and across the atrial septum. Balloon mitral valvuloplasty was performed without complications. This approach should be considered when femoral venous access is restricted or is not feasible.

A novel, transhepatic approach to mitral valvuloplasty is described in a patient with an inferior vena caval filter. After transhepatic transseptal puncture, an lnoue dilatation catheter was passed through the hepatic parenchyma and across the atrial septum. Balloon mitral valvuloplasty was performed without complications. This approach should be considered when femoral venous access is restricted or is not feasible.