left main coronary artery
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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0260770
Author(s):  
Giovanni Luigi De Maria ◽  
Luca Testa ◽  
Jose M. de la Torre Hernandez ◽  
Dimitrios Terentes-Printzios ◽  
Maria Emfietzoglou ◽  
...  

Background Percutaneous coronary intervention (PCI) is used increasingly for revascularization of unprotected left main coronary artery (LMCA) disease. Observational studies and subgroup analyses from clinical trials, have suggested a possible benefit from the use of intravascular ultrasound (IVUS) guidance when performing unprotected LMCA PCI. However, the value of imaging with IVUS has never been proven in an appropriately powered randomized clinical trial. The OPtimizaTIon of Left MAin PCI With IntravascuLar Ultrasound (OPTIMAL) trial has been designed to establish whether IVUS-guided PCI optimization on LMCA is associated with superior clinical outcomes when compared with standard qualitative angiography-guided PCI. Methods The OPTIMAL trial is a randomized, multicenter, international study designed to enroll a total of 800 patients undergoing PCI for unprotected LMCA disease. Patients will be randomized in a 1:1 fashion to IVUS-guided PCI versus angiogram-guided PCI. In patients allocated to the angiogram-guided arm, use of IVUS is discouraged, unless there are safety concerns. In patients allocated to the IVUS guidance arm, pre-procedural IVUS assessment is highly recommended, whilst post-procedural IVUS assessment is mandatory to confirm appropriate stenting result and/or to guide stent result optimization, according to predefined criteria. Patients will be followed up to 2 years after the index procedure. The primary outcome measure is the Academic Research Consortium (ARC) patient-oriented composite endpoint (PoCE) which includes all-cause death, any stroke, any myocardial infarction and any repeat revascularization at 2 years follow-up. Discussion The OPTIMAL trial aims to provide definitive evidence about the clinical impact of IVUS-guidance during PCI to an unprotected LMCA. It is anticipated by the investigators, that an IVUS-guided strategy will be associated with less clinical events compared to a strategy guided by angiogram alone. Trial registration ClinicalTrials.gov: NCT04111770. Registered on October 1, 2019.


2022 ◽  
Author(s):  
Jonathan J Cho ◽  
Samantha D Fabrizio ◽  
Ariana K Tabing ◽  
Gilbert E Boswell ◽  
Gregory J Condos

ABSTRACT Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital abnormality associated with myocardial ischemia and sudden cardiac death. We present a case of a 20 year old previously healthy male presenting with exertional syncope and non-ST elevation myocardial infarction. Coronary computed tomography angiography showed an anomalous left main coronary artery arising from the right coronary cusp with a slit-like appearance, acute angle origin, intramural course, and a subsequent inter-arterial course between the main pulmonary artery and the proximal aorta. Cardiac magnetic resonance imaging demonstrated myocardial infarction in the distribution of the left main coronary artery. The patient underwent successful surgical correction with unroofing of the left main coronary artery. He has had no syncopal episodes or recurrence of chest pain and returned to full duty status in the United States Marine Corps. This case report demonstrates the evaluation and management of a patient with AAOCA.


Author(s):  
David Horne ◽  
Hina Mohsin ◽  
Robert P. Chen

Case report of a unicorn: anomalous double ostium left main coronary artery with common intra-mural connection. Three-dimensional virtual endo-luminal angioscopy and catheter-based imaging confirmed the diagnosis, subsequently avoiding cardiac surgical intervention.


2022 ◽  
Vol 17 (1) ◽  
pp. 232-234
Author(s):  
Michaela Cellina ◽  
Letizia Di Meglio ◽  
Sara Marziali ◽  
Maurizio Cè ◽  
Giancarlo Oliva ◽  
...  

Author(s):  
Nicholas Hess ◽  
Mary Keebler ◽  
Carly A. Fabrizio ◽  
David Kaczorowski

Anomalous coronary arteries arise in a small subset of the population, with each configuration conveying a varying degree of long-term risk. In this report, we describe the discovery of an anomalous single coronary artery with the left main coronary artery arising from the right coronary ostium in a 40-year old male evaluated for cardiac donation. After evaluation, this heart was successfully procured and utilized for orthotopic heart transplantation.


2021 ◽  
Vol 34 (4) ◽  
Author(s):  
Maria Eduarda Menezes de Siqueira ◽  
◽  
Mayra Isabel Dias ◽  
Ana Claudia Vincezi Raudan Uski ◽  
Luciano Figueiredo de Aguiar FilhoLuciano Figueiredo de Aguiar Filho ◽  
...  

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