Canadian Journal of Medicine

Percutaneous coronary intervention through right radial artery access significantly reduces vascular complications compared to femoral access—an 80-year-old woman presented with non-ST segment elevation acute coronary syndromes (NSTE ACS).  Coronary angiography performed using right radial artery access showed left anterior descendent artery disease with multiple stenoses, which was treated percutaneously. Ten minutes after the procedure, the patient presented dyspnea, hypotension, neck edema, and jugular turgor. She was immediately intubated and treated with invasive ventilation, fluid expansion, corticosteroids, and vasopressors. Urgent computerized tomography showed brachiocephalic artery trunk dissection and perforation with extravascular hemorrhage in the mediastinum and neck with venous compression without any sign of aortic, carotid, or subclavian dissection. Two days later, the percutaneous endovascular repair was performed, and a covered self-expanding stent was successfully positioned in the brachiocephalic trunk, sealing the perforation and treating the dissection. The patient progressively recovered and was discharged for rehabilitation. We provided the first report of a brachiocephalic trunk perforation using a radial approach, causing mediastinal and neck hematoma treated with percutaneous endovascular repair showing that vascular complications can be successfully treated percutaneously if be performed by an experienced team.

Aortic valve stenosis (AS) and abdominal aorto-iliac stenosis typically affect elderly patients,
and both are associated with the adverse outcome if not adequately managed. Surgical
intervention is the first treatment in younger patients without significant comorbidities.
Notably, these conditions can be present simultaneously. The choice of the optimal treatment
of these patients is challenging, and no clear recommendations are available, but the option of
simultaneous treatment by percutaneous intervention, especially in high surgical-risk patients,
appeared to be attractive. We report a series of 2 cases with severe AS and aorto-iliac stenosis
referred to "Ospedale del Cuore" of Massa (Italy) who could not undergo surgical intervention.
They were treated with transcatheter aortic valve implantation (TAVI) and covered
endovascular reconstruction of aortic bifurcation (CERAB) within the same procedure. Our
case series showed that one-stage intervention is an effective, safe, and feasible treatment of
these two pathologies. In the future, this approach can represent the "gold-standard" for elderly
and frail subjects

A 45 years old man underwent a surgical replacement of ascending aorta and aortic arch for a
type A aortic dissection. A 3 months CT follow-up documented a significant pseudoaneurysm
close to the aortic root. A percutaneous intervention was successfully performed with the
deployment of four Penumbra Coil inside the pseudoaneurysm, ensuring a proper exclusion
as highlighted in long-term CT follow-up