No abstract

No abstract

Coronary angiography and angioplasty are relatively safe procedures but not without complications. We report an interesting case of effort angina taken for angioplasty of the LCX and assessment of fractional flow reserve (FFR) for the LAD artery lesion in which the tip of the pressure wire was broken and embolised to the LCX while trying to retrieve it. This is the first case report using a hybrid technique with a slip catheter for the successful retrieval of a fractured FFR wire.

A 50-year-old right-handed man (ex-smoker) with a history of left upper limb claudication for the previous 6 years underwent successful left subclavian artery (LSA) angioplasty with stent implantation (8ϫ59 Genesis Stent [Cordis, Warren, NJ]) for 99% ostial and proximal stenosis of the LSA with use of a combined anterograde and retrograde approach ( Figure 1A through 1D). The erythrocyte sedimentation rate and the C-reactive protein were normal. No other vascular system was affected. After an asymptomatic period of 4 months, the patient presented with a history of highgrade fever for 7 days, pain and swelling of the left hand, bluish discoloration of finger tips and palms, and restriction of movements of the fingers of left hand ( Figure 2A). All left upper limb pulses were well felt. A Doppler arterial study of the left upper limb was also normal. At the diagnostic angiogram, fluoroscopy revealed that the LSA stent had transected at multiple levels (4 levels) ( Figure 3A and Movie I of the online-only Data Supplement). The angiogram revealed the presence of 2 pseudoaneurysms, one at the origin of the LSA and another within the distal portion of the stent ( Figure 3B and Movie II of the online-only Data Supplement). Flow within the stent and in the distal portion of the LSA and the brachial artery was normal. The stent fracture at multiple levels had led to pseudoaneurysm formation, throm-

SUMMARYSpontaneous coronary artery dissection (SCAD) is one of the rare causes of acute coronary syndrome in young healthy individuals especially women without having any conventional risk factors for coronary artery disease. We describe a case of 34-year-old healthy man with diffuse multiple SCADs who presented with acute coronary syndrome and was managed conservatively with an uneventful course on long-term follow-up. BACKGROUND