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Procedural related intravascular foreign bodies in vascular and nonvascular areas sometimes leads to abrupted serious complications such as embolization, thrombus development, etc. and necessitating their removal. This can be achieved by avoiding procedural related errors and selecting the appropriate device. The present case represents successfully retrieval of fragmented tip of Simmons catheter using a snare in a 50-year-old woman without any serious consequences Keywords:Catheter, Foreign body, Retrieval, Snare

Objective: To evaluate the technical and procedural success and safety of guide extension catheter-assisted percutaneous coronary intervention (PCI) in challenging and complex coronary lesions. Methods: A physician-initiated, observational study conducted at a tertiary care centre in India between July 2021 and July 2022. The patients who underwent guide extension catheter-assisted PCI with the indication of facilitating stent delivery and deployment were consecutively enrolled in the study. Complete medical records including history, demographics and clinical characteristics, and angiographic data of patients who underwent guide extension catheter-assisted PCI were reviewed and noted. Results: Total 19 patients were included in the study of which 18 underwent guide extension catheter-assisted PCI, and one patient internal carotid artery angioplasty. The mean of patients was 62.74±10.38 years ranging from 42 years to 82 years. Total 9 (47.3%) patients were presented with chronic stable angina, 8 (42.1%) with unstable angina and only one patient represented acute myocardial infarction. The right coronary artery (RCA) was the most common target vessel involved in (63.2%). Total 31.6% lesions were distally located, 57.9% were heavily calcified, and 10.5% lesions were chronic totally occluded. A 100% procedural success was noted with the use of guide extension catheter. No case of stent disruption, vessel dissection or ventricular arrythmias and in-hospital death or myocardial infarction were noted during hospital-stay. Only one case of small access site hematoma was reported. Conclusion: The study concluded that the use of guide extension catheter facilitates easy advancement of stents or other devices through tortuous, heavily calcified, distal, bifurcations and CTOs coronary as well as carotid lesions. However, larger studies on wide range of patient population are required to validate our findings. Keywords: percutaneous coronary intervention, coronary artery, carotid artery, guide catheters

Background Percutaneous coronary intervention (PCI) is the mainstay treatment in patients with coronary artery disease (CAD). The utility of transulnar approach (TUA) has been a topic of debate. Therefore, we aimed to evaluate the safety and efficacy of TUA in this study. Methods This was a prospective, single-center, interventional study conducted between September 2005 and November 2021 at a tertiary-care center in India. Consecutive patients (≥18 years) with CAD requiring PCI using TUA were enrolled in this study. Patients with a negative Allen’s or reverse Allen’s test (>10 seconds), nonpalpable ulnar artery, cardiogenic shock, and the need for a large guiding catheter were excluded. Patients were clinically followed-up at one week to monitor occlusion and 30 days to observe and manage major adverse cardiovascular events (MACE; composite of myocardial re-infarction, target vessel revascularization, disabling stroke, and death). Results A total of 200 patients were enrolled in this study with a mean age of 58.2±10.7 years. Majority of patients (38%) belonged to the age group of 56-65 years and this study observed a male predominance (80.5%). Follow-up of one week revealed no anatomical variations of the ulnar artery and there was no trauma to the ulnar nerve. Ulnar occlusion, however, was seen in three (1.5%) patients. Forearm hematoma was observed in one patient which was then managed conservatively. At 30-days follow-up, (MACE) did not occur in any of the patients. Conclusion In the case that TRA cannot be performed, TUA can be used as a safe and effective alternative access route for PCI, avoiding the transfemoral approach. Keywords: Coronary artery disease, catheterization, transulnar approach, transradial approach

Coronary perforation is an uncommon complication of percutaneous coronary intervention (PCI), that, in extreme cases, might result in cardiac tamponade. Here, we describe a case of coronary artery perforation in a 55-year-old female, presented with recent inferior wall myocardial infraction (IWMI). Coronary angiogram represented right coronary artery (RCA) lesion which was planned to manage with PCI. During PCI, coronary perforation emerged in RCA, leading to cardiac tamponade. Hence an immediate pericardiocentesis was performed and coronary perforation was tackled successfully using a covered stent. Keywords: Coronary perforation, percutaneous coronary intervention (PCI), cardiac tamponade, cath lab nightmare.