Rationale for directional atherectomy and adjunctive stenting in a patient with non-Q wave myocardial infarction.
The development of percutaneous transluminal balloon angioplasty (PTCA) is the greatest revolution in the management of stenotic coronary artery disease. However, PTCA is limited in its application to some specific subgroups of complex lesions such as bifurcational, ostial and plaque burden lesions. For this reason, some new strategies including directional atherectomy (DCA) have been developed as advanced modalities in the treatment of these complex lesions, which if treated by PTCA would certainly yield poor outcomes. We report a case of non-Q wave myocardial infarction resulting from obstruction of the ostium of left anterior descending artery. DCA and adjunctive stenting to the lesion were successfully performed and the patient was discharged uneventfully after the procedure. We suggest that DCA is a striking method and has much merit in the treatment of complex lesions with a high rate of success. In view of consideration of restenosis remains an importantly unresolved problem in percutaneous coronary intervention in specific subgroups of complex lesions. In the future, adequate debulking by mean of DCA in combination with adjunctive stenting which recently emerges as a promising treatment in the prevention of restenosis may provide a more consistent and attractive method for prevention of restenosis in these complex lesions.
Yip
H K
HK
Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Wu
C J
CJ
Yeh
K H
KH
Fu
M
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017073:Atherectomy; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D015607:Stents