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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Left main stem disease: percutaneous coronary intervention vs. coronary artery bypass grafting-what about medical

Edyta Kaczmarska-Dyrda1, Piotr Nikodem Rudziński1, Mariusz Dębski1

  • 1Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszynski National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.

European Heart Journal. Case Reports
|March 6, 2025
PubMed

Insights

Treating left main coronary artery (LMCA) bifurcation stenosis is challenging. Percutaneous coronary intervention (PCI) is an alternative to coronary artery bypass grafting (CABG) for select patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Optimal treatment strategies for left main coronary artery (LMCA) bifurcation lesions remain a clinical challenge.
  • Coronary artery disease (CAD) management requires careful consideration of complex lesion locations.

Observation:

  • A 66-year-old male with CAD risk factors presented with syncope and non-sustained ventricular tachycardia (nsVT).
  • Coronary computed tomography angiography and subsequent coronary angiography revealed LMCA bifurcation stenosis involving the left circumflex artery (LCx) and diagonal branch.

Findings:

  • Percutaneous coronary intervention (PCI) for LMCA bifurcation stenosis involving the ostium of the left anterior descending (LAD) and LCx arteries is technically demanding.
  • Successful PCI of complex LMCA bifurcation lesions requires specialized techniques and careful patient selection.

Implications:

  • Current guidelines often favor coronary artery bypass grafting (CABG) for LMCA stenosis.
  • Advancements in PCI techniques offer a viable alternative to CABG for appropriately selected patients with LMCA bifurcation disease.
  • This case highlights the evolving role of PCI in managing complex coronary artery disease.
Abstract

Keywords:
BifurcationCase reportDouble kissing crush techniqueLeft main coronary artery stenosisPercutaneous coronary intervention

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