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Distal left main trifurcation disease in a patient with porcelain aorta
Ulises Lopez-Peña1, Francisco Garcia-Garcia1, Rogelio Robledo-Nolasco1
1Centro Medico Nacional Hospital 20 de Noviembre ISSSTE, Mexico City, Mexico.
Insights
Coronary trifurcation lesions pose significant challenges during percutaneous coronary intervention (PCI). A complex case involving distal left main trifurcation disease and porcelain aorta was successfully treated using a double mini-crush stenting technique.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Management
Background:
- Coronary trifurcation lesions present greater complexity and higher complication rates during percutaneous coronary intervention (PCI) compared to bifurcations.
- These complex lesions are associated with increased risks of acute periprocedural complications and poorer long-term outcomes, including stent thrombosis and restenosis.
Observation:
- A 73-year-old male patient presented with symptomatic severe aortic stenosis and was diagnosed with distal left main trifurcation disease and porcelain aorta.
- The patient was deemed high-risk for surgical aortic valve replacement and coronary artery bypass grafting due to stroke risk.
Findings:
- A successful percutaneous coronary intervention (PCI) was performed using a novel double mini-crush stenting technique.
- The patient simultaneously underwent trans-catheter aortic valve replacement (TAVR).
Implications:
- This case highlights the feasibility and success of advanced PCI techniques for complex coronary trifurcation disease in high-risk patients.
- The combined PCI and TAVR approach offers a viable alternative for patients with combined complex coronary and aortic pathologies.
Abstract:
Coronary trifurcation lesions are a complex subset of lesions and are substantially more complex than bifurcations when treated with percutaneous coronary intervention (PCI) because of higher rates of acute periprocedural complications (dissection, myocardial infarction, acute vessel closure) and less effective long-term outcomes (stent thrombosis, restenosis) as compared to non-bifurcation lesions. We present the case of a 73-year-old man who was admitted to our hospital with symptomatic severe aortic stenosis who was found to have a distal left main trifurcation disease as well as porcelain aorta on work-up. Given the high risk of stroke during surgical aortic valve replacement and coronary artery bypass grafting, the patient was accepted by the heart team to proceed with percutaneous coronary intervention (PCI) and trans-catheter aortic valve replacement (TAVR). We describe a successful double mini-crush stenting technique approach for this case.