Statin treatment improves endothelial dysfunction and decreases plaque volume in patients with obstructive coronary artery disease (OCAD) as a pleiotropic mechanism. Clinical outcomes in patients with OCAD under statin therapy are favorable compared with those outcomes for patients without statins. However, the effect of statins may be uncertain in patients with vasospastic angina and nonobstructive coronary artery disease (VSA-NOCAD). Several researchers in South Korea and Japan have reported on the effectiveness of statin therapy in patients with VSA-NOCAD. Flow-mediated dilatation was shown to be improved in VSA patients with statins compared with patients without statins. However, statin treatment was shown to not be effective in reducing the major cardiovascular events (MACEs) in patients with VSA-NOCAD, although after propensity score matching, the prognosis was better in patients with VSA-NOCAD. Furthermore, high-intensity statin therapy showed no clinical utility for mitigating MACEs in patients with VSA-NOCAD.

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Coronary artery bypass grafting (CABG) is advantageous for long-term clinical outcomes compared to percutaneous coronary intervention (PCI) in hemodialysis (HD) patients, as PCI has a lower short-term mortality but higher late revascularization risk. Therefore, CABG is very important for HD patients in current clinical practice. In HD patients, the presence of an arteriovenous fistula may lower the flow capacity of the ipsilateral internal thoracic artery (ITA) and induce flow steal, and concomitant microvascular disease (MVD) can cause myocardial ischemia and irreversible myocardial damage even after CABG. The use of the ipsilateral ITA as a free graft or the contralateral ITA as a graft to the left anterior descending artery can be reasonable options. MVD complicates the preoperative evaluation and could worsen clinical outcomes in HD patients. Graft selection and MVD in coronary and systemic circulation are mutually influential future concerns.

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Objective: Placing the internal thoracic artery (ITA) graft ipsilateral to the arteriovenous fistula (AVF) for left anterior descending artery (LAD) revascularization in coronary artery bypass grafting (CABG) in hemodialysis patients may cause coronary steal. However, whether or not ipsilateral or contralateral ITA grafts affect the flow volume and pulsatility index measured based on the transit time flow measurement of the ITA-LAD anastomosis is unclear.
Materials and methods: Between January 2013 and December 2021, 52 hemodialysis patients who underwent CABG with ITA-LAD anastomosis were divided into two groups based on whether the ITA graft was implemented ipsilateral (n = 42) or contralateral (n = 10) to the AVF.
Results: The average age at surgery and the duration of hemodialysis were 65.4 ± 8.4 years old and 82.5 ± 54.5 months in the ipsilateral group and 66.9 ± 9.0 years old and 68.8 ± 52.6 months in the contralateral group. There were no significant differences between the ipsilateral and contralateral groups in terms of LAD stenosis (87.4% ± 12.3% vs. 86.8% ± 15.2%), left ventricular ejection fraction (49.0% ± 15.0% vs. 46.7% ± 14.4%), operation time (376.7 ± 83.2 vs. 407.6 ± 117.5 min), intraoperative flow (40.3 ± 24.0 vs 38.5 ± 16.5 mL/min), and pulsatility index (2.7 ± 1.2 vs. 2.3 ± 0.6) for ITA-LAD. There was no graft occlusion on computed tomography in either group at two weeks postoperatively.
Conclusions: Our study suggests that an ITA graft ipsilateral to the arteriovenous fistula may not always be contraindicated in hemodialysis patients and may be appropriate in most cases.

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Acute coronary occlusion following transcatheter aortic valve implantation (TAVI) is an uncommon but life-threatening complication. We herein report a case of successful immediate bailout of coronary artery occlusion after TAVI. Based on this experience, computed tomography simulation and aortography during balloon aortic valvuloplasty seem to be useful for predicting this complication.

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Acute myocardial infarction due to simultaneous occlusion of two vessels is rare, and few case reports have clearly identified the cause of the simultaneous occlusion of the two vessels in such cases. There is only one case report that discusses coronary artery spasm as the mechanism underlying simultaneous occlusion of two vessels. We herein report a case of acute myocardial infarction due to the simultaneous occlusion of two vessels caused by heparin-induced thrombocytopenia.

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Pneumopericardium is a rare but potentially lethal condition that should not be overlooked. We herein report a case of out-of-hospital cardiac arrest in which pneumopericardium due to cardiopulmonary resuscitation and mechanical ventilation was identified as an impressive radiographic finding during extracorporeal cardiopulmonary resuscitation and percutaneous coronary intervention.

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