Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift under 3D optical coherence tomography: A case report

World Journal of Clinical Cases
Bei-Bei DuYu-Quan He

Abstract

Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists. Left main (LM) bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult. Ostial compromise of the side branch decreases patient prognosis, and its management is still an issue despite the different strategies and devices available. A 42-year-old male patient was admitted to hospital due to chest pain and syncope. Coronary angiography showed acute LM occlusion. Following thrombus aspiration, a LM bifurcation lesion remained. Coronary angiography was repeated one week later, and at the same time, 3D optical coherence tomography (OCT) was carried out to better show the geometry of the bifurcation, which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina. After assessment of the plaque characteristics and the minimum lumen area, the cross-over strategy, kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion. A "moving" carina was found twice during the intervention. Good stent apposition and expansion were confirmed by OCT after proximal optimization technique. The three-month follow-...Continue Reading

References

May 20, 2015·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Hyeon-Cheol GwonManuel Pan
Sep 24, 2016·JACC. Cardiovascular Interventions·Fadi J SawayaYves Louvard
Apr 2, 2018·Journal of the American Heart Association·Ronnie RamadanScott Kinlay
Jul 7, 2018·JACC. Cardiovascular Interventions·Sungsoo ChoYansoo Jang
Mar 13, 2019·Interventional Cardiology·Luca LongobardoCarlo Di Mario
Mar 20, 2019·The International Journal of Cardiovascular Imaging·Yoshinobu MurasatoUNKNOWN 3D-OCT Bifurcation Registry Investigators
May 11, 2019·JACC. Cardiovascular Interventions·Cheol Hyun LeeChang-Wook Nam

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Methods Mentioned

BETA
coronary artery bypass
percutaneous

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