How to perform a percutaneous coronary intervention, when no conventional arterial access site is available: A case...

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is a major global health concern.
• Concomitant peripheral artery disease (PAD) complicates CAD management, increasing cardiovascular event risk and limiting arterial access for interventions.
• Severe aortoiliac and subclavian artery occlusions present significant challenges for percutaneous coronary intervention (PCI).

Observation:

• A patient presented with acute coronary syndrome (ACS) and infrarenal abdominal aorta and bilateral subclavian arterial occlusion.
• Standard femoral arterial access for PCI was not feasible due to extensive PAD.

Findings:

• Successful endovascular stenting of the occluded aortoiliac arteries was performed first.
• Subsequently, percutaneous coronary intervention with stenting of the right coronary artery was achieved.
• This two-stage approach enabled revascularization in a complex case with limited arterial access.

Implications:

• This case demonstrates a viable strategy for managing ACS in patients with extensive PAD and challenging arterial anatomy.
• Endovascular treatment of severe aortoiliac disease can restore arterial access for subsequent coronary interventions.
• Multivessel revascularization is achievable even in the presence of complex, combined coronary and peripheral arterial disease.