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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift
Bei-Bei Du1, Ya-Liang Tong1, Xing-Tong Wang2
1Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China.
Insights
Three-dimensional optical coherence tomography (3D-OCT) aids complex left main bifurcation interventions. This imaging technique improves treatment decisions for challenging coronary artery lesions, leading to successful patient outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Left main (LM) bifurcation lesions pose significant challenges in coronary interventions due to high-risk anatomy and potential for side branch compromise.
- Effective management of ostial side branch compromise remains a critical issue, impacting patient prognosis despite available strategies.
Observation:
- A 42-year-old male presented with chest pain and syncope, diagnosed with acute LM occlusion.
- Post-thrombus aspiration, a complex LM bifurcation lesion was identified.
- Three-dimensional optical coherence tomography (3D-OCT) precisely visualized the bifurcation geometry, revealing stenosis caused by a long carina in the left circumflex artery.
Findings:
- 3D-OCT guided the selection of a cross-over strategy with kissing balloon inflation and proximal optimization technique.
- The intervention involved managing a dynamic "moving" carina.
- Post-intervention OCT confirmed excellent stent apposition and expansion.
Implications:
- 3D-OCT is a valuable tool for complex LM bifurcation lesion assessment and treatment planning.
- Advanced imaging facilitates optimal stent deployment and procedural success in challenging coronary interventions.
- This case highlights the utility of 3D-OCT in improving outcomes for high-risk coronary bifurcation lesions.
Background:
Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists. Left main (LM) bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult. Ostial compromise of the side branch decreases patient prognosis, and its management is still an issue despite the different strategies and devices available.
Case Summary:
A 42-year-old male patient was admitted to hospital due to chest pain and syncope. Coronary angiography showed acute LM occlusion. Following thrombus aspiration, a LM bifurcation lesion remained. Coronary angiography was repeated one week later, and at the same time, 3D optical coherence tomography (OCT) was carried out to better show the geometry of the bifurcation, which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina. After assessment of the plaque characteristics and the minimum lumen area, the cross-over strategy, kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion. A "moving" carina was found twice during the intervention. Good stent apposition and expansion were confirmed by OCT after proximal optimization technique. The three-month follow-up showed good recovery and normal cardiac function.
Conclusion:
3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.
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