Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan.
Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
Am J Case Rep. 2024 Jun 19;25:e944485. doi: 10.12659/AJCR.944485.
BACKGROUND Virtual reality (VR)-guided GC simulation for patients with anatomical anomalies using cardiac computed tomography (CT) has been recently reported. Rotational atherectomy (RA) for the left circumflex (LCX) ostium is challenging due to the tortuous anatomy, acute angulation, and variable vessel size compared to other lesions. The appropriate positioning and coaxiality of the guide catheter (GC) are key factors for safely performing RA. It would be beneficial if it could be simulated prior to percutaneous coronary intervention (PCI). CASE REPORT We treated a 55-year-old man with angina. We performed coronary angiography and detected an ostial calcified lesion of the LCX. We needed RA for this lesion, but PCI was very difficult and challenging. CT revealed right-sided aortic arch with stenosis of left subclavian artery from the Kommerell diverticulum at the distal part of the aortic arch. Therefore, the approach site for PCI was limited. We simulated the appropriate guide catheter and approach site for PCI by VR. PCI was successfully performed with RA, as in the VR simulation. CONCLUSIONS We successfully performed PCI for an ostial calcified lesion of the LCX in a patient with a right-sided aortic arch. Use of VR-guided GC simulation is a useful new option that can help visualize the anatomy and ensure safe procedures for complex lesions.
最近有研究报道了使用心脏计算机断层扫描（CT）对解剖异常患者进行虚拟现实（VR）引导的 GC 模拟。与其他病变相比，左回旋支（LCX）开口处的旋磨术（RA）由于解剖结构扭曲、锐角和血管大小变化，操作具有挑战性。导引导管（GC）的适当定位和同轴性是安全进行 RA 的关键因素。如果能在经皮冠状动脉介入治疗（PCI）前进行模拟，将会很有帮助。
我们治疗了一名 55 岁的心绞痛男性患者。我们进行了冠状动脉造影，发现 LCX 开口处有一处钙化病变。我们需要对这个病变进行 RA，但 PCI 非常困难和具有挑战性。CT 显示主动脉弓右侧伴主动脉弓远端 Kommerell 憩室处左锁骨下动脉狭窄。因此，PCI 的入路部位受到限制。我们通过 VR 模拟了合适的 GC 和 PCI 入路部位。RA 模拟指导下 PCI 成功完成。
我们成功地对一名主动脉弓右侧患者的 LCX 开口处钙化病变进行了 PCI。使用 VR 引导的 GC 模拟是一种有用的新选择，可以帮助可视化解剖结构并确保复杂病变的安全手术。
