Left main artery stenting under percutaneous cardiopulmonary support after right coronary artery ST elevation infarction

The left main coronary artery branches to form the left anterior descending and left circumflex arteries and supplies the entire myocardium of the left ventricle. Treatment guidelines recommend coronary artery bypass grafting in left main coronary artery disease. However, some recent studies have demonstrated that, although the target vessel revascularization rate is relatively high, percutaneous coronary intervention (PCI) has a comparable mortality rate to coronary artery bypass grafting in left main disease. In this case, an 80-year-old male with a recent ST elevation myocardial infarction of the right coronary artery (RCA) was transferred to our hospital for second-stage PCI for left main artery stenosis, which was found incidentally at the time of primary PCI of the RCA. Although he had severely depressed left ventricular function, a drug-eluting stent was implanted successfully in his left main coronary artery with percutaneous cardiopulmonary supportope

Impact of statin treatment on strut coverage after drug-eluting stent implantation

PURPOSE: To evaluate the effect of statin treatment on strut coverage after drug-eluting stent (DES) implantation. MATERIALS AND METHODS: In this study, 60 patients were randomly assigned to undergo sirolimus-eluting stent (SES) or biolimus-eluting stent (BES) implantation, after which patients were randomly treated with pitavastatin 2 mg or pravastatin 20 mg for 6 months. The degree of strut coverage was assessed by 6-month follow-up optical coherence tomography, which was performed in 52 DES-implanted patients. RESULTS: The percentages of uncovered struts were 19.4±14.7% in pitavastatin-treated patients (n=25) and 19.1±15.2% in pravastatin-treated patients (n=27; p=0.927). A lower percentage of uncovered struts was significantly correlated with a lower follow-up low-density lipoprotein (LDL) cholesterol level (r=0.486; p=0.009) and a greater decline of the LDL cholesterol level (r=-0.456; p=0.015) in SES-implanted patients, but not in BES-implanted patients. In SES-implanted patients, the percentage of uncovered struts was significantly lower among those with LDL cholesterol levels of less than 70 mg/dL after 6 months of follow-up (p=0.025), but no significant difference in this variable according to the follow-up LDL cholesterol level was noted among BES-implanted patients (p=0.971). CONCLUSION: Lower follow-up LDL cholesterol levels, especially those less than 70 mg/dL, might have a protective effect against delayed strut coverage after DES implantation. This vascular healing effect of lower LDL cholesterol levels could differ according to the DES type.ope

A Newly Developed Stent Thrombus Related to Optical Coherence Tomography

Optical coherence tomography (OCT) is a useful coronary imaging tool for atherosclerotic plaque characterization and stent evaluation. However, proximal balloon inflation is required in order to reduce signal changes caused by red blood cells and to acquire a clear image. One rare acute complication related to proximal balloon occlusion is micro-thrombus formation. We report a case of multiple, acute micro-thrombi forming after an OCT procedure, despite the use of appropriate prevention for intracoronary thrombus formation.ope

A Case of Endobronchial Lipoma Causing Right Middle and Lower Lobes Collapse and Bronchiolitis Obliterans-organizing Pneumonia

Lipoma is a common neoplasm in soft tissues. However, an intrapulmonary lipoma is a rare benign tumor. Patients with a bronchial lipoma might have a malignant potential related to their smoking history due to the case reports of lung cancer accompanied with lipoma. Endobronchial lipoma can cause irreversible parenchymal lung damage if not diagnosed and treated early. Therefore, it should initially be treated by fiberoptic bronchoscopy or surgery depending on the status of distal parenchymal lung damage. Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome that is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal air spaces. BOOP is caused by drug intoxication, connective tissue disease, infection, obstructive pneumonia, tumors, or an unknown etiology. We encountered a 58 year-old male patient with endobronchial lipoma, causing the collapse of the right middle and lower lobes, and BOOP due to obstructive pneumoniaope

약물용출 스텐트삽입술 후 신생내막형성에 미치는 스타틴의 영향

Dept. of Medicine/석사Background: There is no human data to evaluate impact of statin treatment on strut coverage after drug-eluting stent (DES) implantation. Methods:A total of 60 patients were randomly treated with pitavastatin 2mg or pravastatin 20mg for 6 months after DES implantation. Selection of DES was also randomly assigned to sirolimus-eluting stents (SES) or biolimus-eluting stents (BES). The degree of strut coverage was assessed with 6-month follow-up optical coherence tomography (OCT) which was performed in 52 DES-treated patients. Results:Percentage of uncovered strut was 19.4±14.7% in pitavastain-treated patients (n=25) and 19.1±15.2% in pravastain-treated patients (n=27) (p=0.927); 23.3±16.6% in SES-treated patients (n=28) and 14.5±10.9% in BES-treated patients (n=24) (p=0.026). Lower percentage of uncovered struts was significantly correlated with lower level of follow-up low-density lipoprotein (LDL) cholesterol (r=0.486, p=0.009) and greater reduction of LDL cholesterol level (r=-0.456, p=0.015) in SES-treated patients, but not BES-treated patients. In SES-treated patients, the percentage of uncovered struts was significantly lower in those who follow-up LDL cholesterol level less than 70mg/dL at 6 months follow-up (10.1±12.4% vs. 26.9±15.6%, p=0.025); but there were no significant differences of percentage of uncovered struts between patients who had 6-month follow-up LDL cholesterol level less vs. greater than 70mg/dL in BES-treated patients (14.6±12.7% vs. 14.4±10.5%, p=0.971). Conclusion:lower level of follow-up LDL cholesterol, especially less than 70mg/dL, might have a protective effect against delayed strut coverage after DES implantation. This vascular healing effect of lower LDL cholesterol level could be different according to types of DES.ope

Outcomes of stents covering the deep femoral artery origin.

Aims: To investigate the impact of coverage of the deep femoral artery (DFA) by stents during endovascular treatment of proximal superficial femoral artery (SFA) lesions involving its ostium on the patency of both femoral arteries. Methods and results: We retrospectively analysed 171 limbs of 143 patients who had been treated with femoral bifurcation stenting. According to the stenting strategies, 101 limbs with DFA coverage (group 1) and 70 limbs without DFA coverage (group 2) were compared. SFA and DFA patency was assessed by intra-arterial or computed tomography angiography or duplex ultrasound. Baseline characteristics were similar between groups, except for stent diameter. Flow limitations in DFAs were observed in 13 limbs divided similarly between the groups (8.9% vs. 5.7%, p=0.320). During a median follow-up of 18 months, there was a trend towards higher SFA patency at one and three years in group 1 (83% and 63% vs. 75% and 50%, p=0.124). DFA patency at one and three years was not different between groups (88% and 77% vs. 83% and 71%, p=0.488). Conclusions: Jailing of the DFA origin by SFA ostial stenting did not result in a significant increase in the acute or later loss of patency in either femoral artery.ope