An upfront two-stent strategy for bifurcation stenting of left anterior descending artery in acute coronary syndrome

Authors

  • Mohammad Naeem Malik Pakistan Institute of Medical Sciences, Islamabad-Pakistan.
  • Muhammad Shoaib Pakistan Institute of Medical Sciences, Islamabad-Pakistan.

Keywords:

Acute Coronary Syndrome, Left Anterior Descending Artery, Bifurcation Stenting, DK Crush, Post Stenotic Dilatation.

Abstract

Introduction: This case report presents a unique and noteworthy instance of bifurcation stenting in the left anterior descending coronary artery (LAD) during acute coronary syndrome (ACS). Bifurcation lesions are complex and challenging to treat, and this case contributes valuable insights to the scientific literature by showcasing successful management of LAD bifurcation in the context of ACS.

Case Presentation: The patient, a 50-year-old male with a history of hypertension and hyperlipidemia, presented to the emergency department with severe chest pain and electrocardiogram (ECG) changes indicative of ACS, with raised cardiac troponins. Urgent coronary angiography was planned, which revealed a significant stenosis at the bifurcation of the LAD.

Results: Given the complexity of the lesion and the high-risk presentation, the patient underwent percutaneous coronary intervention (PCI) with a bifurcation stenting approach. A drug-eluting stent was deployed at the LAD bifurcation site using a DK crush technique. The procedure was successful, with restoration of blood flow and resolution of chest pain. The patient was closely monitored and received dual antiplatelet therapy post-PCI.

Conclusion: This case underscores the importance of a tailored approach to treat bifurcation lesions in ACS patients. It highlights the feasibility and efficacy of a two-stent technique for bifurcation stenting in the LAD during ACS. The successful outcome demonstrates that careful planning, expertise, and appropriate stenting strategies can lead to favorable results in complex scenarios. Nevertheless, more research and clinical studies are warranted to establish the best management strategies for such cases, contributing further to the advancement of interventional cardiology.

References

Chen SL, Zhang JJ, Ye F, Chen YD, Patel T, Kawajiri K, Lee M, Kwan TW, Mintz G, Tan HC. Study comparing the double kissing (DK) crush with classical crush for the treatment of coronary bifurcation lesions: the DKCRUSH‐1 Bifurcation Study with drug‐eluting stents. Eur J clin invest. 2008;38(6):361-371.

Chen X, Li X, Zhang JJ, Han Y, Kan J, Chen L, Qiu C, Santoso T, Paiboon C, Kwan TW, Sheiban I. 3-year outcomes of the DKCRUSH-V trial comparing DK crush with provisional stenting for left main bifurcation lesions. JACC: Cardiovasc Interv. 2019;12(19):1927-1937.

Chen SL, Xu BO, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD. Clinical outcome after DK crush versus culotte stenting of distal left main bifurcation lesions: the 3-year follow-up results of the DKCRUSH-III study. Cardiovasc Interv. 2015;8(10):1335-1342.

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Published

2023-09-04

How to Cite

Malik , M. N., & Shoaib , M. (2023). An upfront two-stent strategy for bifurcation stenting of left anterior descending artery in acute coronary syndrome. Cathalogue, 1(1), 13–18. Retrieved from https://pjcvi.com/index.php/Cathalogue/article/view/59

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Section

Articles