Sharma Yash Paul, Santosh Krishna, Panda Prashant, Prasad Krishna, Uppal Lipi, Y S Shrimanth, Pruthvi C R, Dinakar B
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Egypt Heart J. 2020 Aug 4;72(1):47. doi: 10.1186/s43044-020-00081-1.
Diffuse long coronary lesions require long overlapping stents which produce less than optimal long-term results. Sizing of long stents becomes difficult owing to tapering of coronaries and overlapping with excessive metal which makes restenosis a nagging problem on long-term follow-up. The optimal stent sizing becomes even more important when left main (LM) needs to be treated along with left ascending artery (LAD) or left circumflex artery (Lcx). The chronic total occlusions (CTO) represent other complex diffuse coronary lesions which not only require higher expertise and better hardware but also usually long lengths of overlapping stents. The long-tapered sirolimus-eluting stent system (BioMime Morph) has been successfully used in long diffuse lesions in individual coronaries including CTO but the use of the same in LM-LAD/LM-Lcx diffuse lesions has not been explored well where its tapered design can really be favourable.
We here present a case of a 51-year-old hypertensive male presented with NSTEMI and angiography showing left main triple vessel disease with CTO of right coronary artery (RCA). We successfully stented the LM-LAD and RCA (staged) using a long-tapered BioMime Morph system. IVUS was used for optimising the LM-LAD stent. At 6 months follow-up, the patient was doing well on double anti-platelets.
Complex coronary disease, involving the left main and LAD diffusely and CTO of RCA, can be well managed by using a single long-tapered stents thereby avoiding multiple stenting strategy. The stents with decremental diameter will provide better adaptation to the vessel size and their natural tapering. The usage of intravascular imaging helps in better optimisation of stents.
弥漫性长冠状动脉病变需要长的重叠支架，但其长期效果欠佳。由于冠状动脉逐渐变细以及与过多金属重叠，长支架的尺寸确定变得困难，这使得再狭窄成为长期随访中的一个棘手问题。当需要同时治疗左主干（LM）和左前降支（LAD）或左旋支（Lcx）时，最佳支架尺寸的确定变得更为重要。慢性完全闭塞（CTO）代表了其他复杂的弥漫性冠状动脉病变，这类病变不仅需要更高的专业技术和更好的硬件设备，通常还需要长段的重叠支架。长锥形西罗莫司洗脱支架系统（BioMime Morph）已成功用于包括CTO在内的单支冠状动脉的长弥漫性病变，但在LM-LAD/LM-Lcx弥漫性病变中使用该系统的情况尚未得到充分探索，而其锥形设计在这类病变中可能确实具有优势。
我们在此报告一例51岁的高血压男性患者，因非ST段抬高型心肌梗死（NSTEMI）就诊，血管造影显示左主干三支血管病变伴右冠状动脉（RCA）慢性完全闭塞。我们使用长锥形BioMime Morph系统成功地对LM-LAD和RCA进行了分期支架置入。血管内超声（IVUS）用于优化LM-LAD支架。在6个月的随访中，患者在双联抗血小板治疗下情况良好。
累及左主干和LAD的弥漫性病变以及RCA慢性完全闭塞的复杂冠状动脉疾病，可通过使用单个长锥形支架得到良好管理，从而避免采用多个支架的策略。直径递减的支架将更好地适应血管大小及其自然变细情况。血管内成像的使用有助于更好地优化支架。
