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2023, vol. 62, br. 1, str. 66-70
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Strategija revaskularizacije bolesnika sa kritičnim suženjem glavnog stabla leve koronarne arterije u akutnom koronarnom sindromu udruženim sa hroničnom totalnom okluzijom desne koronarne arterije
Revascularisation strategy in the critical left main coronary artery disease associated with acute coronary syndrome and chronic total occlusion of right coronary artery
aKlinički centar Niš, Klinika za kardiovaskularne bolesti, Srbija bKlinički centar Niš, Klinika za kardiovaskularne bolesti, Srbija + Univerzitet u Nišu, Medicinski fakultet, Srbija
e-adresa: bokimaricic@gmail.com
Sažetak
Kritična stenoza glavnog stabla leve koronarne arterije u akutnom infarktu miokarda, praćena kardiogenim šokom, uz hroničnu totalnu okluziju desne koronarne arterije, predstavlja najkompleksniju situaciju za interventnog kardiologa. Urgentna revaskularizacija, hirurška ili perkutana, neophodna je. U našem slučaju, bolesnik muškog pola star 46 godina prezentovan je sa slikom infarkta miokarda bez ST elevacije, praćenog kardiogenim šokom. Hitnom koronarografijom uočena je kritična bifurkaciona stenoza distalnog glavnog stabla leve koronarne arterije i hroničnu totalnu okluziju desne koronarne arterije. Odluka je bila da se uradi intervencija iz dva dela, hitna intervencija na glavnom stablu leve koronarne arterije, a potom za šest meseci rekanalizacija desne koronarne arterije. Na osnovu koronarne anatomije, odluka je bila da se uradi TAP (T and protrusion) tehnika za glavno stablo leve koronarne arterije. Rekanalizacija desne koronarne arterije urađena je nakon šest meseci retrogradnim pristupom preko leve koronarne arterije.
Abstract
Critical left main stenosis combined with chronic total occlusion of the right coronary artery and cardiogenic shock in acute myocardial infarction has been the most challenging case for an interventional cardiologist. Emergency revascularization, CABG or PCI is mandatory. A 46-year-old man presented with non-ST-elevation myocardial infarction and cardiogenic shock. Coronary angiography revealed chronic total occlusion in the middle portion of RCA and severe bifurcation stenosis of the distal left main (LM). LM bifurcation stenosis includes stenosis of the distal LM 80%, ostial stenosis left anterior descending artery (LAD) 80%, ostial stenosis, left circumflex artery (LCX) 90%. A decision was made to perform a two-step procedure, the first one immediately to solve the lesion of the left main, and the PCI CTO RCA in another act. Considering coronary anatomy, we decided to do the "TAP" (T and protrusion) technique for LM. RCA recanalisation was performed six months later.
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