Document Detail

Treatment for LMCA ostial stenosis using a bifurcation technique with a retrograde approach.
MedLine Citation:
PMID:  20088018     Owner:  NLM     Status:  MEDLINE    
A 69-year-old man who underwent coronary artery bypass surgery in February 2008. The surgery included grafting of the left internal thoracic artery (LITA) to the diagonal branch (D1) and a saphenous vein graft (SVG) to the left circumflex artery (LCX) due to ostial stenosis of the left main coronary artery (LMCA). The patient presented with recurring effort chest pain 18 months later. Coronary CT revealed that the LITA-D1 graft was patent, the SVG-LCX graft was occluded, and there was severe ostial stenosis of the LMCA. Coronary angiography was performed in August 2009, but a 5-Fr diagnostic catheter could not be engaged due to the severe ostial stenosis. Percutaneous coronary intervention (PCI) was performed 5 days later with an attempt to cross the lesion with a guidewire using a retrograde approach through the LITA-D1 graft. However, the guidewire could not be crossed using a conventional technique due to the extreme angulation of the LITA-D1 anastomosis. Therefore, we attempted to use a reversed guidewire technique. After crossing the LMCA ostial lesion the retrograde wire was snared through antegradely for insertion of the guiding catheter via the right brachial artery. We were able to engage the guiding catheter in the left coronary artery and implant the stent successfully using the antegrade approach.
Shinichi Shirai; Tatsuki Doijiri; Masashi Iwabuchi
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  75     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-30     Completed Date:  2010-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  748-52     Citation Subset:  IM    
Copyright Information:
(c) 2009 Wiley-Liss, Inc.
Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
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MeSH Terms
Angina Pectoris / etiology
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Angiography / methods
Coronary Artery Bypass / adverse effects*
Coronary Restenosis / etiology,  radiography,  therapy*
Coronary Stenosis / surgery*
Graft Occlusion, Vascular / etiology,  radiography,  therapy*
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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