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  

作　　者：Bei-Bei Du Ya-Liang Tong Xing-Tong Wang Guo-Hui Liu Kun Liu Ping Yang Yu-Quan He 

机构地区：[1]Department of Cardiology,China-Japan Union Hospital of Jilin University,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease,Changchun 130031,Jilin Province,China [2]Department of Hematology and Oncology,Cancer Center,The First Hospital of Jilin University,Changchun 130031,Jilin Province,China

出　　处：《World Journal of Clinical Cases》2020年第4期848-853,共6页世界临床病例杂志

基　　金：Supported by National Natural Science Foundation of China,No.81570360;Beijing Lisheng Cardiovascular Grant,No.LHJJ201612425

摘　　要：BACKGROUND 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.CASE SUMMARY 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-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.BACKGROUND 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.CASE SUMMARY 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, 3 D 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-up showed good recovery and normal cardiac function.CONCLUSION3 D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.

关 键 词：3-Dimensional optical coherence tomography Left main bifurcation Acute myocardial infarction Carina shift Kissing balloon inflation Case report 

分 类 号：R542.22[医药卫生—心血管疾病]