Ahn Seha, Lee Heejin, Choi Jung Suk, Moon Youngkyu, Kim In-Sub, Choi Si Young, Kang Joon Kyu
Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Surg. 2023 Aug 15;10:1236734. doi: 10.3389/fsurg.2023.1236734. eCollection 2023.
Retrograde catheter-induced coronary artery dissection during percutaneous coronary intervention is an exceedingly rare occurrence, and the likelihood of it extending into the aorta is even more uncommon. Typically, surgical treatment involves aortic root replacement combined with coronary artery bypass grafting. However, in this particular case, a meticulous approach was employed. By carefully guiding wires into the true lumens and placing stents in the proximal left main and left anterior descending arteries, the immediate complications were averted by obstructing the retrograde flow in the false lumen. Subsequently, an off-pump coronary artery bypass was performed using the left internal mammary artery to the left anterior descending artery, without the need to manipulate the aorta. This approach resulted in a short operation time and the absence of any other complications.
经皮冠状动脉介入治疗期间逆行导管所致冠状动脉夹层极为罕见，而其延伸至主动脉的可能性更为少见。通常，手术治疗包括主动脉根部置换联合冠状动脉旁路移植术。然而，在这个特殊病例中，采用了一种细致的方法。通过小心地将导丝引入真腔并在左主干和左前降支近端放置支架，通过阻塞假腔内的逆行血流避免了即刻并发症。随后，使用左乳内动脉至左前降支进行非体外循环冠状动脉旁路移植术，无需对主动脉进行操作。这种方法缩短了手术时间且未出现任何其他并发症。
