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Double-barrel coronary artery after subintimal stenting for chronic total occlusion
Yusuke Watanabe1, Yusuke Fujino1, Hisaaki Ishiguro1
1Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
Insights
This case report details subintimal stenting for a chronic total occlusion in a double-barrel coronary artery. Optical coherence tomography confirmed successful stenting with no thrombus, offering insights into complex coronary interventions.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Coronary Artery Disease
Background:
- Chronic total occlusion (CTO) of the right coronary artery (RCA) presents a complex challenge in interventional cardiology.
- Successful revascularization of CTOs often requires advanced techniques due to anatomical complexities.
Observation:
- A 70-year-old male with hypertension, dyslipidemia, and diabetes presented with effort angina due to proximal RCA CTO.
- Coronary angiography revealed a CTO collateralized via septal branches, necessitating a complex stenting approach.
- Three everolimus-eluting stents were implanted, achieving double-barrel flow post-procedure.
Findings:
- Optical coherence tomography (OCT) confirmed subintimal stenting with entry and re-entry into the true lumen.
- Repeat angiography at 10 months showed sustained double-barrel flow through stented and non-stented segments.
- OCT revealed minimal neointimal proliferation and no intraluminal thrombus within the stent.
Implications:
- This represents the first reported case of subintimal stenting for a CTO in a double-barrel coronary artery, assessed by OCT.
- The findings suggest subintimal stenting may be a viable strategy for complex CTOs with unique anatomical configurations.
- OCT provides crucial detailed assessment of subintimal stenting outcomes in challenging coronary lesions.
Abstract:
A 70-year-old man with a medical history of hypertension, dyslipidemia, and diabetes was referred to our hospital for effort angina. Coronary angiography revealed chronic total occlusion (CTO) of the proximal right coronary artery (RCA) that had been collateralized by septal branches from the left anterior descending coronary artery, left circumflex coronary artery, and an antegrade bridge. Three everolimus-eluting stents (Xience-Alpine: 3.0 × 38 mm, 2.75 × 38 mm, and 2.5 × 38 mm; Abbott-Vascular Co., Abbott Park, IL, USA; Fig. 1D, indicated by yellow lines) were implanted with stent overlap. Post-procedural angiography showed double-barrel flow through the RCA. Repeat angiography after 10 months showed double-barrel flow through the RCA, the stented lumen, and the non-stented lumen. Optical coherence tomography (OCT) demonstrated subintimal stenting. OCT revealed that the entry point from the true lumen (TL) was the proximal segment of the RCA, and the re-entry point to the TL was the distal segment of the RCA. Additionally, OCT showed smooth and thin neointimal proliferation inside the deployed stent, and there was no evidence of an intraluminal thrombus. To the best of our knowledge, this is the first report describing a subintimal stenting of CTO lesion involved with double-barrel coronary artery with OCT assessment.
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