Mukhopadhyay Saibal, Muheeb Ghazi, Yusuf Jamal, Kathuria Sanjeev
Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi, Delhi 110002, India.
Eur Heart J Case Rep. 2024 Apr 24;8(5):ytae215. doi: 10.1093/ehjcr/ytae215. eCollection 2024 May.
Acute fracture of a left main (LM) stent during angioplasty is a rare complication. Cardiologists should be aware of the risk of stent fracture (SF) following kissing balloon inflation (KBI) even if the effective diameter of the balloons does not exceed the recommended expansion limits of stents.
A 64-year-old female with hypertension and dyslipidaemia presented with crescendo angina since three months in spite of optimal medical therapy. Coronary angiogram showed a distal LM bifurcation lesion. The patient was admitted for LM bifurcation stenting by upfront two-stent technique (inverted double-kissing Culotte technique). Following first KBI of the stent placed from left circumflex artery (LCX) to LM, there was stent deformation in the LM shaft. As we had planned the Culotte technique, we decided to exclude the fractured segment by stenting from left anterior descending artery (LAD) to LM. The stent from LAD-LM successfully excluded the fractured part of the first stent from the lumen of LM. Optical coherence tomography done after final KBI from LCX-LM revealed successful exclusion of the deformed segment of the LCX stent with mild malapposition at the site of the deformed stent. A follow-up angiogram after six months showed normal in-stent flow with no evidence of restenosis or pseudoaneurysm.
Acute LM SF during coronary intervention can occur even if the effective cumulative diameter of the inflated balloons does not exceed the mentioned expansion limit of stents. Intravascular imaging is a helpful modality to define type of SF and its management.
血管成形术期间左主干（LM）支架急性断裂是一种罕见的并发症。即使球囊的有效直径未超过支架推荐的扩张极限，心脏病专家也应意识到亲吻球囊扩张（KBI）后支架断裂（SF）的风险。
一名64岁患有高血压和血脂异常的女性，尽管接受了最佳药物治疗，但仍在三个月来出现进行性加重的心绞痛。冠状动脉造影显示为LM远端分叉病变。患者入院接受通过预先使用双支架技术（反向双亲吻 Culotte 技术）进行的LM分叉支架置入术。在从左旋支动脉（LCX）至LM置入的支架首次进行KBI后，LM段出现支架变形。由于我们计划采用Culotte技术，我们决定通过从左前降支动脉（LAD）至LM置入支架来排除断裂段。从LAD至LM置入的支架成功地将第一个支架的断裂部分从LM管腔中排除。在从LCX至LM进行最终KBI后进行的光学相干断层扫描显示，成功排除了LCX支架的变形段，变形支架部位存在轻度贴壁不良。六个月后的随访血管造影显示支架内血流正常，无再狭窄或假性动脉瘤的证据。
即使膨胀球囊的有效累积直径未超过上述支架扩张极限，冠状动脉介入治疗期间仍可能发生急性LM-SF。血管内成像有助于确定SF的类型及其处理方法。
