Nomura Tetsuya, Kato Taku, Kubota Hiroshi, Miyawaki Daisuke, Urata Ryota, Sugimoto Takeshi, Higuchi Yusuke, Keira Natsuya, Tatsumi Tetsuya
Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
BMC Cardiovasc Disord. 2016 Aug 2;16(1):157. doi: 10.1186/s12872-016-0335-y.
A lotus root appearance is a rare entity, and there is little opportunity to perform coronary intervention for this kind of lesion. Because of its peculiar anatomical characteristics, one of the problems regarding percutaneous coronary intervention (PCI) for these lesions is related to the involvement of branch vessels.
We encountered a case of PCI for a stenotic lesion with a lotus root appearance in the mid-portion of the right coronary artery (RCA). To avoid the risk of right ventricular (RV) branch occlusion due to stent deployment in the main RCA, we re-crossed the third guidewire into the main RCA via the nearest point to the RV branch ostium through the communicating vascular lumen. Thereafter, we deployed a drug-eluting stent in the main RCA crossing over the RV branch, and the ostium of the RV branch remained intact, as we expected.
This case is the first report in the world describing the details of how to maintain the patency of the side branch bifurcating from a lesion with a lotus root appearance under optical coherence tomography guidance.
莲藕样外观是一种罕见的情况，对这类病变进行冠状动脉介入治疗的机会很少。由于其特殊的解剖特征，针对这些病变进行经皮冠状动脉介入治疗（PCI）的问题之一与分支血管的累及有关。
我们遇到一例在右冠状动脉（RCA）中段有莲藕样外观的狭窄病变进行PCI的病例。为避免因在主RCA中植入支架而导致右心室（RV）分支闭塞的风险，我们通过连通血管腔，经最靠近RV分支开口处的点将第三根导丝重新送入主RCA。此后，我们在跨越RV分支的主RCA中植入了一枚药物洗脱支架，正如我们所期望的，RV分支开口保持完整。
本病例是世界上第一例描述在光学相干断层扫描引导下如何保持从具有莲藕样外观的病变处分叉的侧支血管通畅细节的报告。
