Hendler A, Agranat O
Catheterization Laboratory, Rama Marpeh Hospital, Petah Tikva.
Harefuah. 1998 May 1;134(9):685-6, 751.
We report a case of acute closure of the left main coronary artery, a rare complication of diagnostic cardiac catheterization, treated by emergency stenting prior to aorto-coronary bypass surgery. We suggest encroachment of the Judkins catheter into a calcified left main ostium; with dissection and acute thrombosis of this segment, as the possible mechanism. Clinically, the patient's condition deteriorated to cardiogenic shock and loss of consciousness. Remarkably, there was no angiographic evidence of significant left main coronary artery disease, besides the presence of calcification in the proximal part of the left coronary system and ventricularization of coronary pressure at the time of engagement. We chose to slide quickly the angioplasty guidewire through the left main coronary artery, which allowed prompt mechanical recanalization and rapid restoration of coronary flow, with dramatic clinical and hemodynamic improvement. This relatively simple procedure allowed stenting the left main artery after brief predilation, and the patient came to by-pass surgery in excellent condition. The rationale for surgery in this case was the need for complete coronary revascularization because of significant 3-vessel coronary artery disease.
我们报告一例左主干冠状动脉急性闭塞病例，这是诊断性心导管插入术的一种罕见并发症，在进行主动脉冠状动脉搭桥手术前通过紧急支架置入术进行治疗。我们认为可能的机制是Judkins导管侵入钙化的左主干开口；导致该节段夹层形成和急性血栓形成。临床上，患者病情恶化为心源性休克并失去意识。值得注意的是，除了左冠状动脉系统近端存在钙化以及介入时冠状动脉压力出现心室化外，血管造影没有显示左主干冠状动脉存在明显病变的证据。我们选择迅速将血管成形术导丝滑过左主干冠状动脉，这使得能够迅速实现机械再通并快速恢复冠状动脉血流，临床和血流动力学状况得到显著改善。这个相对简单的操作使得在短暂预扩张后能够对左主干动脉进行支架置入，患者在状况良好的情况下接受了搭桥手术。该病例进行手术的理由是由于严重的三支冠状动脉疾病需要进行完全的冠状动脉血运重建。
