Successful revascularization to right coronary artery by percutaneous coronary intervention after endovascular...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Surgery

Background:

• A 69-year-old male presented with effort angina and impaired left ventricular systolic function.
• Coronary angiography revealed left anterior descending artery chronic total occlusion and right coronary artery (RCA) stenosis.
• Aortography identified concomitant Leriche syndrome (aortoiliac occlusive disease).

Observation:

• The patient's symptoms were stable, prompting a staged interventional approach.
• Endovascular therapy (EVT) was performed first for Leriche syndrome using a bi-directional approach to facilitate subsequent procedures.
• A retrograde approach successfully navigated the occlusive lesion, with stent deployment via a kissing technique.

Findings:

• One week post-EVT, an intra-aortic balloon pump was inserted via the right femoral artery.
• Percutaneous coronary intervention (PCI) to the RCA was successfully completed using an atherectomy device and drug-eluting stents.
• This represents a successful strategy of performing PCI after EVT for Leriche syndrome.

Implications:

• This case highlights a feasible staged interventional strategy for patients with complex coronary artery disease and concomitant Leriche syndrome.
• Successful EVT for Leriche syndrome can enable subsequent critical cardiac interventions like PCI.
• This approach may improve outcomes for patients with combined vascular and coronary pathologies.