Abstract:
An 86-year-old woman was managed for a non-ST-segment elevation myocardial infarction. Coronary angiography revealed significant stenoses at the left anterior descending, left ostial circumflex (LCX), obtuse first marginal, and a Medina 1.0.1 bifurcation lesion at the middle LCX/ second obtuse marginal (OM2). During percutaneous coronary intervention, the rupture of the pre-dilatation balloon was complicated by a type III coronary perforation at the level of the LCX/OM2 bifurcation, leading to cardiac tamponade. Hemodynamics were stabilized by percutaneous pericardial drainage. The placement of a covered stent (BeGraft, Bentley InnoMed), to seal the coronary perforation, was not possible due to its great rigidity and the angulation towards the OM2, even with the use of a guiding catheter extension (Guidezilla, Boston Scientific). To further increase support, we decided to use the flexibility of a regular drug-eluting stent which we implanted from the LCX to the OM2, thereby creating a rail-like path in which the covered stent could then be positioned and deployed successfully, allowing the perforation to be sealed with a good final result. This is what we called the \"buddy stent technique\".
摘要:
一名86岁的女性因非ST段抬高型心肌梗死而接受治疗。冠状动脉造影显示左前降支有明显狭窄,左窦口回旋(LCX),钝角第一边缘,和在中间LCX/第二钝角边缘(OM2)的Medina1.0.1分叉病变。在经皮冠状动脉介入治疗期间,扩张前球囊破裂并发LCX/OM2分叉处的III型冠状动脉穿孔,导致心脏填塞.通过经皮心包引流稳定血流动力学。覆膜支架的放置(Begraft,BentleyInnoMed),密封冠状动脉穿孔,由于其巨大的刚性和朝向OM2的角度,即使使用引导导管延伸(Guidezilla,波士顿科学公司)。进一步加大支持力度,我们决定使用常规药物洗脱支架的灵活性,我们将其从LCX植入OM2,从而创建一条轨道状路径,然后可以在其中成功定位和部署覆膜支架,允许穿孔以良好的最终结果密封。这就是我们所说的“伙伴支架技术”。