Intravascular ultrasound-guided dissection recanalization in a patient with ST-segment elevation myocardial infarction: a case report.

Eur Heart J Case Rep

Division of Cardiovascular Medicine, Hakujikai Memorial General Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Tokyo, Japan.

Published: April 2023

Background: In primary percutaneous coronary intervention (PCI) for acute myocardial infarction, we occasionally experience challenging cases where conventional guidewires cannot pass through the lesion. In such cases, if the use of a tapered guidewire or polymer jacket guidewire is also unsuccessful, coronary artery bypass surgery becomes inevitable. Therefore, other methods to enable revascularization in a reliable and timely manner are desirable.

Case Summary: We present the first case of intravenous ultrasound (IVUS)-guided tip detection (TD)-antegrade dissection re-entry (ADR) in a 73-year-old man who suffered ST-segment elevation myocardial infarction (STEMI). The patient had a total thrombotic occlusion of the right coronary artery and stenotic lesion of the left anterior descending artery. Primary PCI was unsuccessful and IVUS-guided rewiring using a chronic total occlusion (CTO) wire failed due to thrombus attenuation. However, IVUS imaging revealed the presence of intimal and subintimal space, which led us to perform IVUS-guided TD-ADR using Conquest Pro 12 ST (Asahi Intecc). Using the TD method, we were successful in swiftly puncturing the true lumen wall, and a stent was implanted following successful re-entry. Final angiography showed the establishment of Thrombolysis in Myocardial Infraction-3 flow and resolution of ST-segment elevation.

Discussion: IVUS-guided TD enables accurate puncture in an ADR procedure, enabling successful recanalization in a relatively short time. Thus, IVUS-guided TD-ADR is a reliable option for revascularization in STEMI cases wherein the guidewire fails to pass the occlusion using conventional techniques.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117368PMC
http://dx.doi.org/10.1093/ehjcr/ytad172DOI Listing

Publication Analysis

Top Keywords

myocardial infarction
12
st-segment elevation
8
elevation myocardial
8
coronary artery
8
ivus-guided td-adr
8
ivus-guided
5
intravascular ultrasound-guided
4
ultrasound-guided dissection
4
dissection recanalization
4
recanalization patient
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!