Laffan Jack, Shand James, Austin Christopher, Joseph Jijin, Walsh Simon J
Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland.
JACC Case Rep. 2025 Feb 5;30(3):103100. doi: 10.1016/j.jaccas.2024.103100.
A 59-year-old woman presented with non-ST-segment elevation myocardial infarction. Angiography showed severe 3-vessel coronary disease. Percutaneous coronary intervention was successfully performed. We noted a circular opacity in the mid left anterior descending, representing the radio-opaque tip of the guide catheter. Multiple guidewires were entangled around the guide tip to drag it back to the guide. The entrapped tip caught on the circumflex (Cx) stent at the neo-carina. When this was pulled back toward the guide catheter, the deployed left main-Cx stent involuted, elongated, and came back into the aorta. Surgical repair was performed with an aortic dissection. Coronary bypass grafts were anastomosed to the left anterior descending artery and Cx. The patient was discharged home well 5 days later. This case represents a rare complication of percutaneous coronary intervention. If operators are faced with a similar complication they should consider using a guide catheter extension through the already deployed stents. Large-bore femoral access should be considered.
一名59岁女性因非ST段抬高型心肌梗死就诊。血管造影显示严重的三支冠状动脉病变。成功进行了经皮冠状动脉介入治疗。我们注意到左前降支中段有一个圆形不透光区，代表导引导管的不透光尖端。多根导丝缠绕在导引导管尖端以将其拉回到导引导管。被困的尖端卡在新隆突处的回旋支（Cx）支架上。当将其向导引导管拉回时，已植入的左主干-Cx支架内卷、拉长并回到主动脉。进行了主动脉夹层的手术修复。冠状动脉旁路移植术吻合至左前降支和回旋支。患者5天后顺利出院。该病例代表了经皮冠状动脉介入治疗的一种罕见并发症。如果术者遇到类似并发症，应考虑通过已植入的支架使用导引导管延长装置。应考虑采用大口径股动脉入路。
