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Intracranial haemorrhages and lack of efficacy: 4 case reports In a retrospective study of 45 patients with coronary artery fistula (CAF) underwent transcatheter closure at Mayo Clinic, in the USA between 1 October 1997 and 30 September 2018, 4 patients [ages and sexes were not stated] were described, who developed intracranial haemorrhage (n=1) following anticoagulation with heparin or exhibited lack of effectiveness (n=3) following anticoagulation with heparin, unspecified anticoagulants or antiplatelet therapy with aspirin for prevention of thrombosis or stagnation of flow after closure of CAF [routes and dosages not stated]. The patients, who were scheduled for transcatheter closure of CAF, received anticoagulation with heparin bolus dose (n=3) during procedure. All 4 patients underwent transcatheter closure of CAF. After procedure, one patient received unspecified anticoagulation and antiplatelet therapy with aspirin. However, one of the 3 patients, who received heparin during procedure, developed heparin-induced intracranial haemorrhage one day following the CAF. Two patients developed postprocedural MI due to covered stent thrombosis one day post-transcatheter closure (n=1) and stagnation of flow in the right coronary artery at one day post closure (n=1). The one remaining patient, who received aspirin and unspecified anticoagulant, developed MI stagnation of flow in the right coronary artery at one year post-transcatheter closure. The development of MI due to thrombosis and stagnation of flow were suggestive of ineffectiveness of anticoagulants and antiplatelet therapy. The patient, who had MI due to covered stent thrombosis, underwent placement of drug-eluting stent which restored thrombolysis in myocardial infarction-3 (TIMI-3) flow. The patients with MI due to stagnation of flow in the right coronary artery were managed conservatively with no future complications (n=1) and surgical bypass with closure device removal (n=1) [not all outcomes stated]. El-Sabawi B, et al. Transcatheter closure of coronary artery fistula: A 21-year experience. Catheterization and Cardiovascular Interventions 96: 311-319, No. 2, Aug 2020. 803506823 Available from: URL: http://doi.org/10.1002/ccd.28721

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Reactions 17 Oct 2020 No. 1826