Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift under 3D optical coherence tomography: A case report

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.

Double kissing crush technique for treatment of true coronary bifurcation lesions： two-year clinical outcomes from DKCRUSH-1 study

Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.

Provisional Stenting:A Contemporary Relook at the Strategy and Lingering Issues

Bifurcation lesions are encountered and treated in up to 1 in 5 cases of percutaneous coronary intervention(PCI).Such lesions pose a technical challenge to PCI,leading to lower procedural success and a higher rate of long-term adverse events.However,each bifurcation is unique in terms of anatomy and pathological presentation.There is no“one size fits all”strategy for coronary bifurcation PCI.Nevertheless,in most scenarios,provisional stenting is the preferred technique.This method is easy to apply and involves a logical stepwise escalation approach that is highly successful and safe.