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Intravascular ultrasound to assess left main stem coronary artery lesion
S W Davies1, S J Winterton, M T Rothman
1Cardiac Department, London Chest Hospital.
Insights
Intracoronary ultrasound revealed significant left main stem plaque causing 60% narrowing in a 70-year-old man with angina. Coronary bypass surgery successfully relieved his symptoms, highlighting the diagnostic value of intravascular ultrasound.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary arteriography is a standard diagnostic tool for angina.
- Left main coronary artery disease can present subtly.
Observation:
- A 70-year-old male patient presented with angina.
- Coronary arteriography showed subtle abnormalities in the left main stem.
- Intracoronary ultrasound identified extensive plaque in the left main stem and proximal LAD.
Findings:
- Intravascular ultrasound revealed a shelf-like projection causing 60% stenosis in the distal left main stem.
- The plaque extended into the proximal left anterior descending coronary artery.
Implications:
- Intracoronary ultrasound provides detailed plaque morphology and severity assessment.
- Accurate diagnosis of left main stem disease is crucial for treatment planning.
- Coronary artery bypass grafting is an effective treatment for left main stem stenosis.
Abstract:
A man of 70 underwent coronary arteriography for the assessment of angina. The appearance of the left coronary main stem was slightly abnormal but no definite stenosis could be delineated. Intracoronary ultrasound examination with a 4.8 French intravascular ultrasound probe showed an extensive plaque in the distal left main stem and proximal left anterior descending coronary artery, with a shelf-like projection causing 60% narrowing at one point in the distal left main stem. Since coronary bypass surgery the patient has been free of angina.