Coronary artery anomalies are a diverse group of congenital disorders, with a reported incidence of 0.6 – 1.3%. Congenital absence of the LCX is an extremely rare anomaly, with a frequency of only 0.003% in all patients who undergo coronary angiography. Here, we present a case of 76-year-old female who had an episode of chest pain while she was hospitalized for management of small bowel obstruction with elevated troponin and coronary angiogram showed super-dominant right coronary artery without any obstructive disease.

Pulmonary artery pseudoaneurysm due to mycobacterium tuberculosis is a rare clinical entity. A 29 years old female presented to us with hemoptysis. She was a known case of pulmonary tuberculosis and was on antitubercular treatment. Emergency transcatheter coil embolization of the neck of the sac of pseudoaneurysm arising from the right descending pulmonary artery was done. At 6 months of follow up, the patient was asymptomatic. We are reporting this case due to a rare presentation of pulmonary artery pseudoaneurysm due to mycobacterium tuberculosis and pulmonary artery as an unusual source of hemoptysis instead of the bronchial artery.

BACKGROUND: Arterio-venous (AV) fistula is created for patients requiring renal replacement therapy (hemodialysis and hemofiltration). A failing A-V fistula requires urgent treatment to keep it patent. Understanding the simple tips and tricks will contribute to the quality of life for the patient with end-stage renal disease and reducing radiation dose to the operator. CASE SUMMARY: A 77 year old male with end-stage renal disease, hypertension and coronary artery disease. He has been on regular haemodialysis after A-V fistula (left forearm) was constructed in 2013. He presented with 2 weeks history of A-V fistula occlusion. Examination was essentially normal. Serum sodium=136mmol/l, potassium=5.5mmol/l urea=100mg/l, creatinine=3.5mg/dl. The Doppler scan showed 50 % stenosis just proximal to the anastomosis with calcification. Percutenous arteriography and venography was done with non-compliance balloon (3x12mm) up to 24 atm . The post procedure venography showed restoration of flow across the fistula. CONCLUSION: Endovascular treatment of a failing A-V fistula can be life saving. The simple tips and tricks of using the groin route, reducing the concentration of contrast and maneuver devices may contribute to safety and reduce radiation to the operator.

Aim: The transradial approach (TRA) has taken an upswing, however access-site complications still exist. The choice of potentially less traumatic materials may minimize these complications. This article describes the use of a hydrophilic-coated 6F guiding catheter for diagnostic and interventional procedures and upper extremity dysfunction following these procedures. Materials and Methods: This prospective observational study enrolled 217 patients who underwent elective transradial percutaneous coronary intervention (TR-PCI) for stable and unstable angina, or acute coronary syndrome between May 2014 and November 2016. All patients were treated using a 6F hydrophilic-coated guiding catheter (PRIMUM, PendraCare, Wellinq, the Netherlands). Catheter performance was assessed on a five-point scale ranging from very bad to very good. Procedure safety was assessed using the Major cardiac and cerebrovascular events (MACCE) criteria. Results: The average number of guiding catheters used was 1.2 per patient. Overall performance of the catheters was rated Average/Good. Procedural success, defined as TIMI grade 3 flow and successful stent deployment, with a residual diameter stenosis of <25%, was 97.7%. MACCE occurred in 1.5% during the 6-months of follow-up. Conclusion: These data indicate that the use of a hydrophilic-coated guiding catheter to perform percutaneous coronary interventions is safe and effective, with high procedural success and low complication rates. In addition, the short and long-term MACCE outcomes of the PCI were favorable.

Even though most vertebral artery anomalies are asymptomatic, but the normally arising vertebral artery from the superoposterior surface of its ipsilateral subclavian artery, plays a vital role, via the Subclavian Steal Syndrome to help in vascularization of its ipsilateral upper limb anatomical structures. The case of a left vertebral artery with a proximal origin stenosis in the left limb of a 72 year -old female cadaver is reported and its pathophysiological consequences of the stenosis in an hypothesized proximal occlusion in ipsilateral subclavian artery considered. The left vertebral artery originated normally from the superior -posterior surface of the left subclavian artery, but with a proximal stenotic origin in its proximal 1-1/2mm length. The LVA was of a good caliber size distal to the stenotic segment, proceeding in its pre-foraminal segment superiorly, entering normally the 6th transverse cervical foraminal to begin its osseous path. Proximal stenosis of the vertebral artery are uncommon, but this tends to have a deleterious effect on the posterior circulation in the brain depending on the severity of such stenosis. Stenosis although most frequent in the artery’s 1st part tends to have more deleterious effect with Knowledge of vertebral artery pathologies, its variant origins, lumen size, are important to Head and Neck, Neurosurgeons, Interventional Neuroradiologists in the choice of appropriate surgical and medical managements and to neuroradiologists in the interpretation of images.