Akut ST Yükselmeli Miyokard Enfarktüsünde Sol Ana Koroner Stentleme Olgusu

Öz

Mevcut çalışmalar ışığında, sol ana koroner arter (LMCA) lezyonları stabil ve planlı hastalarda cerrahiye daha uygundur. Ancak, LMCA lezyonlarının bu stentlemesinde OCT, FFR ve IVUS gibi invaziv araçlar, girişimsel kardiyoloji çağında prosedürel optimizasyon için popülerlik kazanmaktadır. Uzun vadeli sonuçlar tartışmalı olmasına rağmen, kısa süreli çalışmalar stentleme ve cerrahi arasında aynı mortalite ve morbidite oranlarını ortaya koymuştur. Burada, sol koroner sistemde distal akış olmaksızın LMCA'nın total obstrüksiyonu nedeniyle hemodinamik bozukluğu olan akut anteriyor ST yükselmeli miyokard enfarktüslü (MI) hastaya acil şartlarda yapılan crush stentleme işlemini sunuyoruz.

Anahtar Kelimeler

• Sol Ana Koroner
• Stentleme
• Cerrahi

The Case of Left Main Coronary Stenting in Acute ST Elevation Myocardial Infarction

Öz

In the light of present studies, the left main coronary artery (LMCA) lesions more suitable for surgery on stable and planned patients. But invasive tools like OCT, FFR and IVUS usage in this stenting of LMCA lesions gains popularity for procedural optimization in interventional cardiologist era. Although long term results are debatable but short term studies revealed same mortality and morbidity rates between stenting and surgery in acute coronary syndromes. We herein present an acute anterior ST elevation myocardial infarction (MI) with hemodynamic disturbance because of total obstruction of LMCA with no distal flow in left coronary system. After crush stenting of LMCA, patient’s situation was going well and discharged with medical therapy shortly after intervention.

Anahtar Kelimeler

• Left Main Coronary Artery
• Stenting
• Surgery.

Kaynakça

1. Higami, H, Toyofuku, M, Morimoto, T, Ohya, M, Fuku, Y, Yamaji, K et al., Acute Coronary Syndrome With Unprotected Left Main Coronary Artery Culprit - An Observation From the AOI-LMCA Registry, Circulation Journal, 2018, 25, 83(1), 198-208.
2. Sousa-Uva, M, Neumann, F.J, Ahlsson A, Fernando A, Adrian, P.B, Umberto, B, et al., 2018 ESC/EACTS Guidelines on myocardial revascularization, European Heart Journal, 2019, 40, 3096.
3. Gani, B, Fjolla, Z.B, Gjin, N, Fernando, A, Shpend, E, Zarife, R, et al., Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials, Journal of Clinical Medicine, 2020, 9, 2231.
4. Javier, V.A, Hector, T, Dawn, A.J, Issam, D.M, John, M.C, Stephen W, et al., Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative JAMA Cardiology, 2019, 4, 100–109.
5. Doucet, S, Jolicœur, E.M, Serruys, P.W, Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease: analysis from the EXCEL trial, American Heart Journal, 2019, 214, 9–17.
6. Yousif, A, James, P.H, Ahran, A.D, Christopher, M.C, Megha, P, Ziad, A.A, et al., Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials, European Heart Journal, 2020, 41, 3228–3235.