Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 848-853
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.848
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
Bei-Bei Du, Ya-Liang Tong, Xing-Tong Wang, Guo-Hui Liu, Kun Liu, Ping Yang, Yu-Quan He
Bei-Bei Du, Ya-Liang Tong, Guo-Hui Liu, Kun Liu, Ping Yang, Yu-Quan He, Department 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
Xing-Tong Wang, Department of Hematology and Oncology, Cancer Center, The First Hospital of Jilin University, Changchun 130031, Jilin Province, China
Author contributions: Du BB and Wang XT were the patient’s physicians; He YQ, Du BB and Liu GH performed the coronary angiography and coronary intervention; Tong YL helped with the 3D reconstruction; Liu K helped with acquisition of data; Du BB, Yang P, and He YQ reviewed the literature and contributed to manuscript drafting; Du BB, Wang XT, and He YQ were responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81570360; Beijing Lisheng Cardiovascular Grant, No. LHJJ201612425.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Quan He, MD, PhD, Chief Doctor, Full Professor, Deputy Director, Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, No. 126 Xiantai Street, Changchun 130031, Jilin Province, China. heyq@jlu.edu.cn
Received: December 12, 2019
Peer-review started: December 12, 2019
First decision: December 12, 2019
Revised: December 31, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: February 26, 2020
Processing time: 75 Days and 23.5 Hours
Abstract
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.

Keywords: 3-Dimensional optical coherence tomography; Left main bifurcation; Acute myocardial infarction; Carina shift; Kissing balloon inflation; Case report

Core tip: Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists. Left main bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult. Here we report the diagnosis and management of a 42-year-old male patient who had an acute left main myocardial infarction and carina shift during the follow-up coronary intervention. 3D optical coherence tomography facilitated display of the bifurcation geometry. In addition, a “moving” carina due to carina shift and tissue protrusion was also verified by 3D optical coherence tomography.