title: Instructive percutaneous coronary intervention to avoid the risk of side branch occlusion at a lesion with a lotus root appearance: a case report.
abstract: A lotus root appearance is a rare entity, and there is little opportunity to perform coronary intervention for this kind of lesion. Because of its peculiar anatomical characteristics, one of the problems regarding percutaneous coronary intervention (PCI) for these lesions is related to the involvement of branch vessels.
  
  
  
  We encountered a case of PCI for a stenotic lesion with a lotus root appearance in the mid-portion of the right coronary artery (RCA). To avoid the risk of right ventricular (RV) branch occlusion due to stent deployment in the main RCA, we re-crossed the third guidewire into the main RCA via the nearest point to the RV branch ostium through the communicating vascular lumen. Thereafter, we deployed a drug-eluting stent in the main RCA crossing over the RV branch, and the ostium of the RV branch remained intact, as we expected.
  
  
  
  This case is the first report in the world describing the details of how to maintain the patency of the side branch bifurcating from a lesion with a lotus root appearance under optical coherence tomography guidance.
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan. t2-ya@nike.eonet.ne.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nomura
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kubota
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Miyawaki
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Urata
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Higuchi
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Natsuya
authors.initials: N
authors.lastname: Keira
authors.affiliation: Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan City, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tatsumi
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Bifurcation; Case report; Dual lumen microcatheter; Lotus root appearance; Optical coherence tomography; Side branch