Precision Percutaneous Coronary Intervention of a Complex Lesion
| Autor: | Fawaz Bardooli, Nooraldaem Yousif, Tajammul Hussain, Husam A Noor |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Pharmacology medicine.medical_specialty business.industry medicine.medical_treatment Perforation (oil well) Percutaneous coronary intervention Stent Context (language use) General Medicine Lithotripsy Coronary Angiography Balloon Coronary Vessels Atherectomy Percutaneous Coronary Intervention Treatment Outcome medicine Balloon dilation Humans Stents Radiology business Aged |
| Zdroj: | Reviews on Recent Clinical Trials. 16:220-224 |
| ISSN: | 1574-8871 |
| DOI: | 10.2174/1574887115666201009123721 |
| Popis: | Background: Balloon dilation and atherectomy have limitations in the treatment of heavily calcific coronary lesions. Introduction: Intravascular lithotripsy (IVL) is a state-of-the-art system that modifies severe calcific coronary plaques efficiently. In this paper, we report our experience with IVL in the context of a calcific in-stent chronic total occlusion. Case summary: A 75-year-old gentleman whose status was post percutaneous coronary intervention, with the deployment of two overlapping bare-metal stents in the mid-left anterior descending artery (LAD) 20 years ago, was admitted to our cardiac center for the elective intervention of in-stent chronic total occlusion (CTO) of LAD, which was performed using an antegrade wire escalation (AWE) technique. After recanalization of the CTO body, optical coherence tomography pullback confirmed a very high calcium score. Balloon dilatation attempts failed, so we proceeded with shockwave lithotripsy with successful full expansion of the 3.5-mm IVL balloon followed by a straightforward stent delivery. The procedure was complicated by distal wire perforation, which was handled in a timely manner with coil embolization. The patient’s postoperative course was uneventful. Conclusion: This case illustrates the feasibility and effectiveness of IVL that powerfully cracks coronary calcium while minimizing vessel wall trauma in the context of heavily calcific in-stent CTO. In our case, coronary perforation occurred in a small-caliber side branch, which was identified in a timely manner before hemodynamic compromise and treated successfully straight away with coil embolization. |
| Databáze: | OpenAIRE |
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