title: Primary percutaneous coronary intervention of an unprotected left main using mini-crush drug-eluting stents facilitated by intracoronary reteplase.
abstract: Patients suffering from acute myocardial infarction with involvement of unprotected left main (LM) coronary artery disease represent a very high-risk subgroup. A 37-year-old male patient was admitted with posterolateral acute myocardial infarction and in borderline hemodynamic condition. His left ventricular ejection fraction was 30% with posterior, lateral wall, and apical akinesis along with mild mitral regurgitation. Emergency coronary angiography demonstrated ostial occlusion of the left circumflex artery (without stump, flow Thrombolysis in Myocardial Infarction 0/Rentrop 0) and severe distal LM disease with superimposed thrombus. The primary percutaneous coronary intervention procedure combined intracoronary reteplase plus thrombus aspiration to restore flow in the left circumflex and deployment of two everolimus-eluting stents with mini-crush technique to successfully reconstruct the LM bifurcation. The patient recovered without complications and had a favorable outcome at mid-term.
authors.affiliation: Cardiology Department, General Hospital K.A.T., Athens, Greece. kontriad@gmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Metaxopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Babalis
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D011994:Recombinant Proteins / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013318:Stroke Volume; D013396:Suction; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D000068338:Everolimus; C087896:reteplase; D010959:Tissue Plasminogen Activator; D020123:Sirolimus