Oh Seok, Kim Ju Han, Hyun Dae Young, Cho Kyung Hoon, Kim Min Chul, Sim Doo Sun, Hong Young Joon, Ahn Youngkeun, Jeong Myung Ho, Jung Yochun
Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea.
Front Cardiovasc Med. 2022 Mar 2;9:778815. doi: 10.3389/fcvm.2022.778815. eCollection 2022.
Some cases of percutaneous coronary intervention (PCI) for the anastomotic site between the Cabrol-type conduit and the left main coronary artery (LMCA) have been reported. Nevertheless, the combination of PCI with a detailed description of lesion appearance using virtual histology-intravascular ultrasound (VH-IVUS) has never been reported. In this study, we present a case of acute myocardial infarction that was successfully treated with intravascular ultrasound (IVUS)-guided PCI for focal stenosis at the anastomotic site, and the plaque composition was studied in detail.
A 35-year-old Korean male with Behçet's disease was diagnosed with acute myocardial infarction. He had previously undergone three cardiothoracic surgeries including two aortic replacements, followed by modified Bentall operation with a Cabrol-type aortocoronary anastomosis. Coronary angiogram (CAG) showed focal critical stenosis at the anastomosis site between the conduit and the LMCA, and VH-IVUS showed fibrotic plaque with mainly fibrous tissue but without a confluent necrotic core. PCI was performed using a drug-eluting stent (4.5 × 12 mm, Synergy, Boston Scientific, Marlborough, MA, USA). Since a repeat CAG and IVUS post-surgery showed an under-expanded stent strut, post-dilation ballooning was additionally performed. Subsequently, the repeat IVUS revealed wellapposed and optimized deployment of the drug-eluting stent with full lesion coverage. Final CAG showed optimal angiographic results. After successful PCI, the patient's anginal symptoms improved dramatically, and he was successfully discharged from our hospital.
This study presents an IVUS-guided PCI case for an anastomotic site between the conduit and the LMCA. It is the first to investigate the characteristics of this lesion through VH-IVUS, which demonstrated the presence of fibrous plaques at the anastomotic site. IVUS radiofrequency data allow for a detailed assessment of plaque composition and provide new insights into the histopathological nature of stenotic lesions at the anastomotic site, especially in patients with chronic inflammatory diseases like Behçet's disease.
已有关于经皮冠状动脉介入治疗（PCI）应用于卡布罗尔型血管桥与左主干冠状动脉（LMCA）吻合部位的一些病例报道。然而，PCI联合使用虚拟组织学血管内超声（VH-IVUS）对病变外观进行详细描述的情况尚未见报道。在本研究中，我们报告了一例急性心肌梗死患者，其通过血管内超声（IVUS）引导的PCI成功治疗了吻合部位的局灶性狭窄，并对斑块成分进行了详细研究。
一名35岁患有白塞病的韩国男性被诊断为急性心肌梗死。他此前接受过三次心胸外科手术，包括两次主动脉置换，随后进行了改良的本塔尔手术及卡布罗尔型主动脉冠状动脉吻合术。冠状动脉造影（CAG）显示血管桥与LMCA吻合部位存在局灶性严重狭窄，VH-IVUS显示为纤维化斑块，主要由纤维组织构成，无融合性坏死核心。使用药物洗脱支架（4.5×12mm，Synergy，美国波士顿科学公司，马尔伯勒，马萨诸塞州）进行PCI。由于术后重复CAG和IVUS显示支架小梁未充分扩张，遂额外进行了后扩张球囊扩张。随后，重复IVUS显示药物洗脱支架贴壁良好且部署优化，病变完全覆盖。最终CAG显示血管造影结果理想。PCI成功后，患者的心绞痛症状显著改善，并成功从我院出院。
本研究展示了一例针对血管桥与LMCA吻合部位的IVUS引导下PCI病例。这是首次通过VH-IVUS研究该病变的特征，结果显示吻合部位存在纤维斑块。IVUS射频数据有助于详细评估斑块成分，并为吻合部位狭窄病变的组织病理学性质提供新的见解，尤其是对于像白塞病这样的慢性炎症性疾病患者。
