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Acute Total LMCA Occlusion and Successful TAP Stenting: Which Strategy Should We Follow in STEMI?
Akut Total LMCA Tıkanıklığı ve Başarılı TAP Stentleme: STEMI'da Hangi Stratejiyi İzlemeliyiz?
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(2):84-8
doi: 10.5336/cardiosci.2020-73421
Makale Dili: EN
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ABSTRACT
The incidence of acute total left main coronary artery (LMCA) occlusion cannot be fully determined precisely, given that most of patients die unfortunately before hospital arrival. This patient group is rarely encountered but mortality is very high due to endangered a large area of myocardium and increases the risk of cardiogenic shock and lethal arrhythmia quickly. We report a case of a 40-year-old woman presented with acute anterolateral myocardial infarction and was managed successful with percutaneous intervention with TAP (T-stenting And small Protrusion) technique stenting. According to current guidelines in LMCA disease, coronary artery bypass graft (CABG) is preferred, but percutaneous coronary intervention (PCI) is life-saving treatment strategy in emergencies for hemodynamic instability patient. On the other hand, there is no specific recommendations given concerning treatment for STEMI due to LMCA and optimal revascularitazion strategy is still uncertain because of absence of a randomized trial. Alternative treatments are; primary angioplasty-stenting, emergency CABG, primary angioplasty followed by emergency CABG.
Keywords: Percutaneous coronary intervention; coronary occlusion; transluminal coronary balloon angioplasty
The incidence of acute total left main coronary artery (LMCA) occlusion cannot be fully determined precisely, given that most of patients die unfortunately before hospital arrival. This patient group is rarely encountered but mortality is very high due to endangered a large area of myocardium and increases the risk of cardiogenic shock and lethal arrhythmia quickly. We report a case of a 40-year-old woman presented with acute anterolateral myocardial infarction and was managed successful with percutaneous intervention with TAP (T-stenting And small Protrusion) technique stenting. According to current guidelines in LMCA disease, coronary artery bypass graft (CABG) is preferred, but percutaneous coronary intervention (PCI) is life-saving treatment strategy in emergencies for hemodynamic instability patient. On the other hand, there is no specific recommendations given concerning treatment for STEMI due to LMCA and optimal revascularitazion strategy is still uncertain because of absence of a randomized trial. Alternative treatments are; primary angioplasty-stenting, emergency CABG, primary angioplasty followed by emergency CABG.
Keywords: Percutaneous coronary intervention; coronary occlusion; transluminal coronary balloon angioplasty
ÖZET
Akut total sol ana koroner arter (LMCA) oklüzyon insidansı hastaların çoğunun hastaneye gelmeden önce ölmesi sebebiyle tam olarak belirlenememektedir. Bu hasta grubuna nadiren rastlanır, ancak geniş bir miyokard alanının tehlikeye girmesi kardiyojenik şok ve ölümcül aritmi riskini artırarak mortaliteyi yükseltir. Biz 40 yaşında, akut anterolateral miyokard infarktüsü ile acil servise başvuran ve TAP tekniği ile başarılı perkütan koroner girişim (PKG) yapılan olguyu sunuyoruz. Mevcut kılavuzlara göre ciddi LMCA hastalığında koroner arter bypass greft (KABG) öncelikli olarak tercih edilen tedavi yöntemidir, ancak hemodinamik açıdan instabil olan acil vakalarda PKG hayat kurtarıcı tedavidir. Öte yandan, LMCA total tıkanıklığından gelişen STEMI tedavisi için spesifik bir tavsiye verilmemiştir. Ayrıca bu konuda randomize bir çalışma olmadığı için optimal revaskülarizasyon stratejisi hala belirsizdir. Primer anjiyoplasti ve stentleme, acil KABG, primer anjiyoplasti ardından acil KABG alternatif tedavi yöntemleridir.
Anahtar Kelimeler: Perkütan koroner girişim; koroner tıkanıklık; transluminal koroner balon anjioplasti
Akut total sol ana koroner arter (LMCA) oklüzyon insidansı hastaların çoğunun hastaneye gelmeden önce ölmesi sebebiyle tam olarak belirlenememektedir. Bu hasta grubuna nadiren rastlanır, ancak geniş bir miyokard alanının tehlikeye girmesi kardiyojenik şok ve ölümcül aritmi riskini artırarak mortaliteyi yükseltir. Biz 40 yaşında, akut anterolateral miyokard infarktüsü ile acil servise başvuran ve TAP tekniği ile başarılı perkütan koroner girişim (PKG) yapılan olguyu sunuyoruz. Mevcut kılavuzlara göre ciddi LMCA hastalığında koroner arter bypass greft (KABG) öncelikli olarak tercih edilen tedavi yöntemidir, ancak hemodinamik açıdan instabil olan acil vakalarda PKG hayat kurtarıcı tedavidir. Öte yandan, LMCA total tıkanıklığından gelişen STEMI tedavisi için spesifik bir tavsiye verilmemiştir. Ayrıca bu konuda randomize bir çalışma olmadığı için optimal revaskülarizasyon stratejisi hala belirsizdir. Primer anjiyoplasti ve stentleme, acil KABG, primer anjiyoplasti ardından acil KABG alternatif tedavi yöntemleridir.
Anahtar Kelimeler: Perkütan koroner girişim; koroner tıkanıklık; transluminal koroner balon anjioplasti
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