Mitsiadis Sotirios, Miaris Nikolaos, Dimopoulos Antonios, Theodosis-Georgilas Anastasios, Tsiamis Spyridon, Patsourakos Nikolaos, Papakonstantinou Nikolaos, Pisimisis Evangelos
Department of Cardiology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece.
Case Rep Cardiol. 2020 May 18;2020:9493519. doi: 10.1155/2020/9493519. eCollection 2020.
While complete revascularization in coronary artery disease is of high priority, the method of implementation in patients with complex coronary lesions and multiple comorbidities is not directed by published guidelines. . A 53-year-old female with a chronic total occlusion of the right coronary artery and a bifurcation lesion of the left anterior descending artery and the first diagonal branch, presented with non-ST elevation myocardial infarction. Her past medical history concerned thymectomy and prior chest radiation for thymoma, myasthenia gravis, peripheral artery disease, and cervical cancer treated with surgery and radiation. Although SYNTAX score II favored surgical revascularization, the interventional pathway was finally successfully followed. However, it was complicated with vessel perforation and tamponade managed with pericardiocentesis.
Comorbidities are not all involved in common risk models and require individualization until more evidence comes to light.
虽然冠状动脉疾病的完全血运重建至关重要，但对于患有复杂冠状动脉病变和多种合并症的患者，实施方法并未遵循已发表的指南。一名53岁女性，右冠状动脉慢性完全闭塞，左前降支和第一对角支存在分叉病变，表现为非ST段抬高型心肌梗死。她既往有胸腺切除术史，曾因胸腺瘤、重症肌无力、外周动脉疾病和宫颈癌接受过胸部放疗及手术和放疗。尽管SYNTAX评分II支持外科血运重建，但最终成功采用了介入途径。然而，该过程出现了血管穿孔和心包填塞，通过心包穿刺术进行了处理。
合并症并非都包含在常见风险模型中，在有更多证据之前需要个体化处理。
