Rosović Ivan, Avdagić Damir, Miškulin Rajko
Thalassotherapia Opatija - Clinic for rehabilitation, treatment and prevention of heart and blood vessels diseases.
Acta Clin Croat. 2024 Mar;63(Suppl1):116-120. doi: 10.20471/acc.2024.63.s1.22.
A case report of a 63-year-old man who was indicated for invasive coronarography during outpatient treatment. The completed coronarography confirmed a significant stenosis in the highly calcified right coronary artery (RCA). In order to determine the hemodynamic significance of the borderline significant stenosis of the curved branch of the left coronary artery, FFR was performed. Despite the use of non-compliance balloons and high-pressure OPN balloons during elective PCI-RCA, the lesion in question could not be predilated, resulting in the need for the patient to undergo PCI-RCA with rotablation. During the repeated PCI-RCA procedure, the proximal and middle segments were subjected to rotablation. Non-compliant balloon catheters were used to perform a successful predilatation of the middle segment lesion and to try to place a stent in the designated lesion. Due to the calcified curve of the proximal segment, the stent was unable to pass through while being retracted into the leading catheter, causing it to fall into the proximal segment. The stent balloon was used to push the stent and insert it into the curve between the proximal and middle segment. A small balloon catheter (1.2 x 15 mm) successfully passed through the unexpanded stent. After subsequent inflating of the small balloon catheter and further inflating of larger balloons the lost stent was fully expanded and implanted with optimal control coronarography findings.
一名63岁男性患者的病例报告，该患者在门诊治疗期间接受了有创冠状动脉造影。完整的冠状动脉造影证实高度钙化的右冠状动脉（RCA）存在严重狭窄。为了确定左冠状动脉弯曲分支临界显著狭窄的血流动力学意义，进行了血流储备分数（FFR）测定。尽管在择期经皮冠状动脉介入治疗右冠状动脉（PCI-RCA）期间使用了非顺应性球囊和高压定向斑块旋切（OPN）球囊，但相关病变无法预扩张，导致患者需要接受旋磨术的PCI-RCA治疗。在重复的PCI-RCA手术过程中，对近端和中段进行了旋磨。使用非顺应性球囊导管成功对中段病变进行了预扩张，并试图在指定病变处放置支架。由于近端节段的钙化弯曲，支架在回缩到引导导管时无法通过，导致其掉入近端节段。使用支架球囊推动支架并将其插入近端和中段之间的弯曲处。一个小的球囊导管（1.2×15mm）成功通过未扩张的支架。随后对小球囊导管进行充气，并进一步对较大球囊充气后，丢失的支架完全扩张并植入，冠状动脉造影结果显示控制良好。
