Takagi Kensuke, Yoshida Ruka, Fujita Tomoyuki, Noguchi Teruo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan.
J Soc Cardiovasc Angiogr Interv. 2023 Mar 11;2(3):100609. doi: 10.1016/j.jscai.2023.100609. eCollection 2023 May-Jun.
The left main (LM) coronary artery stenosis is associated with high morbidity and mortality and has traditionally been treated with coronary artery bypass grafting. However, in recent years, advancements in device technology and adjunctive pharmacotherapy have led to the widespread use of percutaneous coronary intervention (PCI) as a treatment for unprotected LM lesions. Despite this, LM lesions are often complex, involving distal bifurcation and heavy calcification, which increases the risk of coronary perforation (CP) during PCI. In addition, the use of rotational or orbital atherectomy in severely calcified LM bifurcation lesions carries a higher risk of complications and in-hospital mortality than that in non-LM lesions. CP is a rare but potentially fatal complication of PCI, particularly in cases of Ellis grade III (CP-G3), with a high rate of cardiac tamponade and mortality. The management of CP-G3 in LM distal bifurcation lesions is challenging and requires specialized techniques. This article presents a flowchart of bail-out strategies for CP-G3 in LM distal bifurcation lesions and provides detailed procedures for each technique. Furthermore, we highlight the challenges and limitations of each technique, requiring careful management when CP-G3 occurs in LM distal bifurcation lesions.
左主干（LM）冠状动脉狭窄与高发病率和死亡率相关，传统上采用冠状动脉旁路移植术进行治疗。然而，近年来，设备技术和辅助药物治疗的进步使得经皮冠状动脉介入治疗（PCI）作为无保护左主干病变的治疗方法得到了广泛应用。尽管如此，左主干病变通常较为复杂，涉及远端分叉和严重钙化，这增加了PCI过程中冠状动脉穿孔（CP）的风险。此外，在严重钙化的左主干分叉病变中使用旋磨或轨道旋切术比非左主干病变具有更高的并发症风险和院内死亡率。CP是PCI的一种罕见但可能致命的并发症，尤其是在Ellis III级（CP-G3）病例中，心包填塞和死亡率较高。左主干远端分叉病变中CP-G3的处理具有挑战性，需要专门技术。本文介绍了左主干远端分叉病变中CP-G3的补救策略流程图，并提供了每种技术的详细操作步骤。此外，我们强调了每种技术的挑战和局限性，当左主干远端分叉病变发生CP-G3时需要谨慎处理。
