Bailout Bifurcation strategy in Primary PCI

Abstract

Background: Primary percutaneous coronary intervention (PCI) is a critical procedure for managing acute ST elevation myocardial infarction (MI). Bifurcation lesions, in particular, pose unique challenges during PCI, necessitating specialized strategies to optimize procedural success and minimize adverse outcomes.

Case Presentation: We present a case of a 60-year-old male with a history of hypertension who presented with acute anterior ST elevation MI complicated by acute atrial fibrillation at 2 AM. Coronary angiography revealed acute proximal to mid total occlusion of the left anterior descending artery (LAD) and a large first diagonal branch. Despite encountering challenges during the procedure, including the need for bailout bifurcation stenting, successful restoration of normal sinus rhythm was achieved with electrical cardioversion.

Management & Results: The patient was discharged after 72 hours and scheduled for staged PCI to the right coronary artery. The use of the inverse culotte technique in this case highlights the importance of meticulous angiographic assessment and adaptability in managing unexpected complexities during primary PCI.

Conclusion: Follow-up revealed stable clinical outcomes, emphasizing the significance of comprehensive post-procedural care and long-term medication adherence. Additionally, discussions underscore the technical considerations and potential limitations associated with culotte stenting, particularly in cases with narrow bifurcation angles.