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A planned hybrid culotte stenting procedure in the setting of an acute STEMI
Chitradeep De1, Medhat Zaher, Mayur Lakhani
1Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York 10305, USA.
Insights
This case study presents a hybrid Culotte technique for treating complex coronary artery bifurcation lesions during acute ST-elevation myocardial infarction. This approach balances restenosis risk with stent thrombosis for optimal patient outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Coronary artery bifurcation lesions pose significant challenges in percutaneous coronary intervention due to anatomical complexity and risk of side branch closure.
- Acute ST-segment elevation myocardial infarction (STEMI) necessitates prompt and effective treatment strategies.
Purpose of the Study:
- To report a novel hybrid Culotte technique for managing a complex bifurcation lesion in the setting of STEMI.
- To evaluate the feasibility and long-term outcomes of using different stent types (bare metal stent and drug-eluting stent) in a hybrid approach.
Main Methods:
- A 57-year-old male patient with STEMI and a 1,1,1 Medina classification bifurcation lesion was treated.
- A bare metal stent (BMS) was deployed in the culprit D1 branch, and a drug-eluting stent (DES) was placed in the left anterior descending (LAD) artery.
- The hybrid Culotte technique was employed to address both lesions simultaneously.
Main Results:
- Successful procedural outcome with excellent long-term results reported.
- The chosen stent strategy aimed to minimize risks of restenosis (with BMS) and stent thrombosis (with DES).
Conclusions:
- This is the first reported case of a successful hybrid Culotte technique for STEMI involving a complex bifurcation lesion.
- The hybrid approach offers a balanced risk profile, mitigating restenosis and stent thrombosis concerns.
Introduction:
Bifurcation lesions have traditionally presented a unique problem for interventional cardiologists because of their inherent anatomy and risk of closure of the side branch, after a percutaneous intervention for the primary lesion of the main branch.
Case Presentation:
We report the case of a 57-year-old man who presented with acute ST-segment elevation myocardial infarction secondary to a 100% occlusion at the ostium of first diagonal (D1) branch. Patient also had a 70% stenosis of the mid-segment of the left anterior descending (LAD) coronary artery at the D1 branching point (1,1,1 Medina classification). A bare metal stent (BMS) was deployed at the site of the culprit lesion in the D1, while a drug eluting stent (DES) was placed in the LAD. We believe that the BMS at the culprit thrombotic, inflamed site in D1 is more likely to re endothelialize than a DES and the DES in the LAD, is less likely to re-stenose than a BMS.
Conclusion:
This is the only reported case, where in the setting of an acute ST elevation myocardial infarction, a hybrid Culotte technique was successfully performed with excellent long-term results, thus achieving an acceptable balance of risks between restenosis (in the case of a BMS) and stent thrombosis (in the case of a DES).
