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Double set up technique as a bailout of diagonal branch coronary perforation: a case report Syukri, Muhammad; Yanni, Mefri; Syafri, Masrul; Phalguna, Shindu; Firmansyah, Alles; Indah, Merlin Sari Mutma; Mahendra, Ivan; Zulkarnain, Hadi
Medical Journal of Indonesia Vol. 33 No. 1 (2024): March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.247266

Abstract

Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). A 55-year-old male with a history of implanted stent on the left main ostium to the proximal left circumflex artery (LCX) and distal right coronary artery, and chronic total occlusion (CTO) on ostium left anterior descending (LAD). PCI was performed using a stiff wire to cross the CTO body in LAD. We performed an injection and confirmed the presence of extravasation. We successfully managed to stop the bleeding by placing the tips of floppy wire that were cut into pieces. A drainage pathway was made through thoracotomy for pericardial effusion. Angiography showed persisting extravasation at the wire insertion site. We then made our own covered stent. We implanted on the osteal LAD until proximal LCX. Repeated angiography showed no contrast extravasated from the perforation site, and the patient was stabilized and discharged.
Utilizing the CHA₂DS₂-VASc-HSF Score to Predict Subclinical Acute Kidney Injury from Contrast Agents: A Focus on Neutrophil Gelatinase-Associated Lipocalin Biomarker : SCI-AKI and CHA₂DS₂-VASc-HSF Score Syafri, Masrul; Firmansyah, Alles; Mutma Indah, Merlin Sari; Muya, Yui
Scientific Journal Vol. 4 No. 6 (2025): SCIENA Volume IV No 6, November 2025
Publisher : CV. AKBAR PUTRA MANDIRI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56260/sciena.v4i6.287

Abstract

Background: Contrast-Induced Acute Kidney Injury (CI-AKI) is a common complication in patients undergoing Percutaneous Coronary Intervention (PCI), with Subclinical Contrast-Induced Acute Kidney Injury (SCI-AKI) detectable via biomarkers like Neutrophil Gelatinase-Associated Lipocalin (NGAL). The CHA₂DS₂-VASc score, developed for stroke risk in atrial fibrillation, has been modified to CHA₂DS₂-VASc-HSF for assessing cardiovascular risk, but its role in predicting SCI-AKI remains unclear. Objectives: This study aimed to evaluate the CHA₂DS₂-VASc-HSF score as an indicator for SCI-AKI risk in PCI patients, using NGAL as a biomarker for early kidney injury. Methods: A cohort study was conducted at Dr. M. Djamil General Hospital, Padang, from May to December 2024. Thirty-four patients with stable and unstable angina undergoing PCI were included. NGAL levels were measured before and after PCI. Statistical analysis examined the relationship between CHA₂DS₂-VASc-HSF score and SCI-AKI. Results: Nine patients (26.5%) were diagnosed with SCI-AKI. NGAL levels showed a significant difference between SCI-AKI positive and negative groups (p < 0.05), but no significant association was found between CHA₂DS₂-VASc-HSF score and SCI-AKI (p > 0.05). Discussion: The CHA₂DS₂-VASc-HSF score is effective for cardiovascular risk assessment but not for SCI-AKI prediction. SCI-AKI was better predicted by NGAL, a sensitive biomarker of early kidney injury. This study highlights the importance of combining multiple risk factors for accurate SCI-AKI risk stratification in PCI patients. Conclusion: The CHA₂DS₂-VASc-HSF score is not a reliable predictor for SCI-AKI. NGAL remains a valuable biomarker for early detection, emphasizing the need for a multifactorial approach in managing renal complications post-PCI.