Chaddad Rima, Nasrallah Jamil, Sajjad Waseem, Jun Eran Sim Wen, Khialani Bharat
Cardiology Department, Grand Hospital de l'Est Francilien, France.
General Medicine Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Life Sciences Department, Faculty of Sciences, Lebanese University, Beirut, Lebanon.
Int J Surg Case Rep. 2025 Jun;131:111386. doi: 10.1016/j.ijscr.2025.111386. Epub 2025 May 1.
High-risk percutaneous coronary intervention (PCI) with mechanical circulatory support has emerged as an alternative to coronary artery bypass grafting (CABG) for patients with complex left main coronary artery disease who are at high surgical risk.
A 69-year-old woman with diabetes mellitus, hypertension, hyperlipidemia, and a prior stroke presented with non-ST-segment elevation myocardial infarction. Echocardiography revealed a left ventricular ejection fraction of 25 %. Coronary angiography showed heavily calcified distal left main disease with critical ostial stenosis of the left anterior descending (LAD) and left circumflex (LCX) arteries. Deemed unsuitable for CABG, she underwent high-risk PCI with Impella mechanical support. Rotational atherectomy and intravascular lithotripsy were employed to address extensive calcification. A drug-coated balloon angioplasty was performed from the left main to the LCX, and a drug-eluting stent was placed from the left main into the mid-LAD. Post-dilation ensured optimal stent apposition and vessel patency.
Mechanical circulatory support provided essential hemodynamic stability during the complex PCI procedure. Advanced lesion modification techniques, including rotational atherectomy and intravascular lithotripsy, were crucial for treating the heavily calcified lesions, facilitating optimal stent deployment, and minimizing procedural risks.
The hybrid PCI approach combining mechanical support and advanced interventional techniques was effective in managing complex coronary artery disease in a high-risk patient contraindicated for CABG. This strategy offers a viable alternative for patients with significant anatomical and clinical challenges, emphasizing the importance of tailored therapeutic interventions in contemporary interventional cardiology.
对于具有复杂左主干冠状动脉疾病且手术风险高的患者，采用机械循环支持的高风险经皮冠状动脉介入治疗（PCI）已成为冠状动脉旁路移植术（CABG）的替代方案。
一名69岁女性，患有糖尿病、高血压、高脂血症，既往有中风史，因非ST段抬高型心肌梗死就诊。超声心动图显示左心室射血分数为25%。冠状动脉造影显示左主干远端严重钙化病变，左前降支（LAD）和左旋支（LCX）动脉开口处严重狭窄。因被认为不适合进行CABG，她接受了使用Impella机械支持的高风险PCI。采用旋磨术和血管内冲击波碎石术处理广泛钙化。从左主干至LCX进行了药物涂层球囊血管成形术，并从左主干至LAD中段置入了药物洗脱支架。后扩张确保了支架的最佳贴壁和血管通畅。
机械循环支持在复杂的PCI手术过程中提供了至关重要的血流动力学稳定性。先进的病变修饰技术，包括旋磨术和血管内冲击波碎石术，对于治疗严重钙化病变、促进最佳支架置入以及将手术风险降至最低至关重要。
结合机械支持和先进介入技术的混合PCI方法在治疗CABG禁忌的高风险患者的复杂冠状动脉疾病方面是有效的。该策略为面临重大解剖和临床挑战的患者提供了一种可行的替代方案，强调了当代介入心脏病学中量身定制治疗干预措施的重要性。
