Abstract：
BACKGROUND Virtual reality (VR)-guided GC simulation for patients with anatomical anomalies using cardiac computed tomography (CT) has been recently reported. Rotational atherectomy (RA) for the left circumflex (LCX) ostium is challenging due to the tortuous anatomy, acute angulation, and variable vessel size compared to other lesions. The appropriate positioning and coaxiality of the guide catheter (GC) are key factors for safely performing RA. It would be beneficial if it could be simulated prior to percutaneous coronary intervention (PCI). CASE REPORT We treated a 55-year-old man with angina. We performed coronary angiography and detected an ostial calcified lesion of the LCX. We needed RA for this lesion, but PCI was very difficult and challenging. CT revealed right-sided aortic arch with stenosis of left subclavian artery from the Kommerell diverticulum at the distal part of the aortic arch. Therefore, the approach site for PCI was limited. We simulated the appropriate guide catheter and approach site for PCI by VR. PCI was successfully performed with RA, as in the VR simulation. CONCLUSIONS We successfully performed PCI for an ostial calcified lesion of the LCX in a patient with a right-sided aortic arch. Use of VR-guided GC simulation is a useful new option that can help visualize the anatomy and ensure safe procedures for complex lesions.
摘要：
背景技术最近已经报道了使用心脏计算机断层扫描(CT)对具有解剖异常的患者进行虚拟现实(VR)引导的GC模拟。由于曲折的解剖结构，左旋弯曲（LCX）口的旋转粥样斑块切除术（RA）具有挑战性，急性成角,与其他病变相比，血管大小可变。引导导管(GC)的适当定位和同轴度是安全进行RA的关键因素。如果可以在经皮冠状动脉介入治疗（PCI）之前进行模拟，那将是有益的。病例报告我们治疗了一名55岁的心绞痛患者。我们进行了冠状动脉造影，并检测到LCX的口钙化病变。我们需要RA治疗这个病变，但是PCI非常困难和具有挑战性。CT显示右侧主动脉弓，主动脉弓远端Kommerel憩室的左锁骨下动脉狭窄。因此,PCI的入路部位有限.我们通过VR模拟了PCI的合适引导导管和入路部位。已成功使用RA进行PCI,就像在VR模拟中一样。结论我们成功地对右侧主动脉弓患者的LCX口钙化病变进行了PCI。使用VR引导的GC模拟是一个有用的新选择，可以帮助可视化解剖结构并确保复杂病变的安全程序。
