Talanas Giuseppe, Siciliano Roberta, Canonico Mario Enrico, Parodi Guido
Dipartimento di Cardiologia, Azienda Ospedaliero-Universitaria di Sassari, Sassari.
G Ital Cardiol (Rome). 2020 Nov;21(11 Suppl 1):58S-59S. doi: 10.1714/3487.34674.
A 53-year-old male was admitted to our department for unstable angina. Coronary angiography showed a subocclusive stenosis in the ostial-proximal tract of an intermediate branch in the context of a left dominance system. We proceeded with an ad hoc percutaneous coronary intervention considering this intermediate branch lesion in the setting of a bifurcation (Medina 0,0,1), where the proximal and distal main branches were represented by the left main and left anterior descending (LAD) arteries, respectively. After pre-dilation of the intermediate branch lesion, we advanced a "safety balloon" in order to protect the LAD branch and, simultaneously, we deployed a 3.0/22 mm drug-eluting stent in the intermediate branch. After in-stent post-dilation, we felt a strong resistance during the guidewire removal from the LAD indicating a wire entrapment. After a vigorous traction of the jailed guidewire, we observed the accidental removal of the just deployed stent from the guiding catheter. We re-advanced a guidewire on the LAD and a 3.25/23 mm drug-eluting stent was successfully implanted on the intermediate branch. We briefly discuss the occurred complication and some technical aspects regarding this case.
一名53岁男性因不稳定型心绞痛入住我科。冠状动脉造影显示在左优势系统背景下，中间支开口近端段存在次全闭塞性狭窄。鉴于此中间支病变处于分叉部位（Medina分型0,0,1），其中近端和远端主支分别由左主干和左前降支（LAD）动脉代表，我们进行了临时经皮冠状动脉介入治疗。在对中间支病变进行预扩张后，我们推进一个“安全球囊”以保护LAD分支，同时，我们在中间支置入了一枚3.0/22 mm药物洗脱支架。在支架内后扩张后，当从LAD撤出导丝时我们感觉到强烈阻力，提示导丝陷入。在用力牵拉被困导丝后，我们观察到刚置入的支架意外地从引导导管中脱出。我们在LAD上重新推进一根导丝，并成功在中间支植入一枚3.25/23 mm药物洗脱支架。我们简要讨论了该病例中发生的并发症及一些技术方面的问题。
