Author + information
- Received December 18, 2012
- Accepted January 3, 2013
- Published online December 1, 2013.
- Yusuke Fujino, MD∗,
- Guilherme F. Attizzani, MD†,
- Satoko Tahara, MD, PhD∗,
- Kensuke Takagi, MD∗,
- Hiram G. Bezerra, MD, PhD†,
- Sunao Nakamura, MD, PhD∗ and
- Marco A. Costa, MD, PhD†∗ ()
- ∗Division of Cardiology, New Tokyo Hospital, Chiba, Japan
- †Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. Marco A. Costa, Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, Ohio 44106.
- frequency-domain optical coherence tomography
- kissing-balloon technique
- unprotected left main coronary artery
A 67-year-old man with a history of hypertension and dyslipidemia was admitted because of angina symptoms. Coronary angiography (CAG) showed an eccentric lesion of the distal unprotected left main coronary artery (ULMCA) involving the ostium of the left anterior descending coronary artery (LAD) (Fig. 1A). ULMCA/LAD crossover stent implantation was conducted with a 3.5 × 18-mm everolimus-eluting stent (EES) (XIENCE PRIME, Abbott Vascular, Santa Clara, California) at 12 atm, followed by the kissing-balloon technique (KBT). Despite a favorable CAG result (Fig. 2A), frequency-domain optical coherence tomography (FD-OCT) revealed stent strut deformation towards the LAD, leading to a large area of malapposition, mainly because of balloon inflation over an inadequate guidewire position (i.e., behind the stent struts) in the left circumflex coronary artery (LCX) (Fig. 2). Information provided by FD-OCT ultimately oriented the guidewire removal and repositioning in the LCX, as well as additional intrastent post-dilation in the ULMCA–LAD with a noncompliant balloon (3.5 × 12 mm) at 22 atm. Marked reduction in stent strut malapposition and adequate stent expansion were demonstrated (Fig. 2).
In the present case, FD-OCT images depicted the poor results with the KBT after ULMCA percutaneous coronary intervention (PCI), results that were otherwise unrevealed by CAG, thereby demonstrating the potential role of FD-OCT to guide PCI in ULMCA distal bifurcation. Whether FD-OCT guidance can improve clinical outcomes in this scenario remains to be determined.
Dr. Attizzani has received consultant honoraria from St. Jude Medical. Dr. Bezerra has received honoraria fees from St. Jude Medical. Dr. Costa is on the speakers’ bureaus of and is a consultant for Daiichi-Sankyo, St. Jude Medical, Boston Scientific, sanofi-aventis, Eli Lilly and Company, and Medtronic; and is on the speakers’ bureaus and scientific advisory boards of Abbott Vascular, Cordis, St. Jude Medical, and Scitech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 18, 2012.
- Accepted January 3, 2013.
- American College of Cardiology Foundation