scholarly journals A high risk unstable case of left main bifurcation lesion treated with simultaneous kissing stents as salvage procedure

2020 ◽  
Vol 8 (2) ◽  
pp. 764
Author(s):  
Brajesh Kumar Kunwar ◽  
Vikrant Pawar ◽  
Ravneet Singh Villkhoo ◽  
Shivram Mishra
Keyword(s):  
Emergency Situation ◽  
Coronary Intervention ◽  
Salvage Procedure ◽  
Left Main ◽  
Coronary Syndrome ◽  
Bifurcation Lesion ◽  
Percutaneous Coronary ◽  
Unstable Case ◽  
St Elevation ◽  
Bifurcation Lesions

Bifurcation treatment with percutaneous coronary intervention is still one challenging task especially the left main bifurcation. And it becomes still more challenging when it is done in emergency situation in a very unstable patients. There are many one-stent and two-stent approaches available to treat the bifurcation lesions but no approach has proven superior to other. Here, we present a case of a 78-year-old male diagnosed with distal left main bifurcation lesion treated with simultaneous kissing stents technique presented with acute coronary syndrome, non-ST elevation myocardial infarction with pulmonary oedema in cardiogenic shock.

scholarly journals Primary percutaneous coronary intervention for a left main bifurcation lesion without stenting using excimer laser with optical coherence tomography guidance: a case report

2020 ◽  
Vol 4 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Masahiro Hada ◽  
Tomoyo Sugiyama ◽  
Yoshihisa Kanaji ◽  
Tsunekazu Kakuta
Keyword(s):  
Optical Coherence Tomography ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Left Main ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

Abstract Background Optimal strategy for treating bifurcation lesions or lesions with large thrombus in left main disease remains elusive. Excimer laser coronary angioplasty (ELCA) is a therapeutic option for thrombotic lesions in acute coronary syndrome. Case summary A 68-year-old man with chest pain was transferred to our emergency department, and subsequently diagnosed as inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed a 75% stenosis in the left main trunk (LMT). Optical coherence tomography (OCT) showed massive thrombus at the distal LMT to the ostial left anterior descending artery (LAD) and left circumflex artery (LCx). ELCA was performed in the three directions from LMT to proximal LAD, proximal LCx, and obtuse marginal branch. OCT after ELCA showed reduction of thrombus and no apparent plaque rupture or calcification, implying that coronary thrombosis was caused by OCT-defined plaque erosion. Intracoronary electrocardiogram of the LCx showed ST-segment elevation which corresponded to inferior ST-segment elevation, whereas no intracoronary electrocardiogram ST-segment elevation was detected for LAD. Taking all of the data including angiographic appearance, OCT-derived residual lumen size and residual thrombus volume, and strategic options into consideration, we completed percutaneous coronary intervention without stent deployment. He has been free from any cardiac events thereafter for 8 months. Discussion Optimal strategy of coronary intervention for bifurcation lesions, especially LMT bifurcations, remains elusive. ELCA may have a potential to safely reduce intracoronary thrombus in patients presenting with acute coronary syndrome with OCT guidance.

Percutaneous interventional cardiac procedures

2020 ◽  
pp. 3655-3666
Author(s):  
Edward D. Follan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Thrombolytic Therapy ◽  
Coronary Intervention ◽  
Salvage Procedure ◽  
Basic Technique ◽  
Coronary Syndrome ◽  
Percutaneous Catheter ◽  
Cardiac Procedures ◽  
Percutaneous Coronary ◽  
St Elevation

Percutaneous coronary intervention is the term applied to a variety of percutaneous, catheter-based procedures that accomplish revascularization by angioplasty (enlargement of a vessel lumen by modification of plaque structure), stenting (deployment of an internal armature or stent), atherectomy (removal or ablation of plaque), or thrombectomy (removal of thrombus). The most common single indication for percutaneous coronary intervention is acute coronary syndrome. Randomized trials have shown that direct intervention for ST-elevation myocardial infarction is superior to initial thrombolytic therapy when performed in appropriate centres, and it can be used as a salvage procedure after failed thrombolytic therapy. Balloon angioplasty is the traditional, basic technique of coronary intervention, but this is now uncommonly employed as a stand-alone treatment. A variety of percutaneous techniques can be used to remove atheroma or thrombus from coronary arteries as a prelude to angioplasty/stenting.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

Sign in / Sign up

Export Citation Format

Share Document