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Intravascular ultrasound-guided dissection recanalization in a patient with ST-segment elevation myocardial infarction: a case report.
Sangen, Hideto; Wakita, Masaki; Toguchi, Riku; Tanaka, Kunio.
Afiliación
  • Sangen H; Division of Cardiovascular Medicine, Hakujikai Memorial General Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Tokyo, Japan.
  • Wakita M; Division of Cardiovascular Medicine, Hakujikai Memorial General Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Tokyo, Japan.
  • Toguchi R; Division of Cardiovascular Medicine, Hakujikai Memorial General Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Tokyo, Japan.
  • Tanaka K; Division of Cardiovascular Medicine, Hakujikai Memorial General Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Tokyo, Japan.
Eur Heart J Case Rep ; 7(4): ytad172, 2023 Apr.
Article en En | MEDLINE | ID: mdl-37090749
Background: In primary percutaneous coronary intervention (PCI) for acute myocardial infarction, we occasionally experience challenging cases where conventional guidewires cannot pass through the lesion. In such cases, if the use of a tapered guidewire or polymer jacket guidewire is also unsuccessful, coronary artery bypass surgery becomes inevitable. Therefore, other methods to enable revascularization in a reliable and timely manner are desirable. Case summary: We present the first case of intravenous ultrasound (IVUS)-guided tip detection (TD)-antegrade dissection re-entry (ADR) in a 73-year-old man who suffered ST-segment elevation myocardial infarction (STEMI). The patient had a total thrombotic occlusion of the right coronary artery and stenotic lesion of the left anterior descending artery. Primary PCI was unsuccessful and IVUS-guided rewiring using a chronic total occlusion (CTO) wire failed due to thrombus attenuation. However, IVUS imaging revealed the presence of intimal and subintimal space, which led us to perform IVUS-guided TD-ADR using Conquest Pro 12 ST (Asahi Intecc). Using the TD method, we were successful in swiftly puncturing the true lumen wall, and a stent was implanted following successful re-entry. Final angiography showed the establishment of Thrombolysis in Myocardial Infraction-3 flow and resolution of ST-segment elevation. Discussion: IVUS-guided TD enables accurate puncture in an ADR procedure, enabling successful recanalization in a relatively short time. Thus, IVUS-guided TD-ADR is a reliable option for revascularization in STEMI cases wherein the guidewire fails to pass the occlusion using conventional techniques.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Qualitative_research Idioma: En Revista: Eur Heart J Case Rep Año: 2023 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Qualitative_research Idioma: En Revista: Eur Heart J Case Rep Año: 2023 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido