title: Double-barrel coronary artery after subintimal stenting for chronic total occlusion.
abstract: A 70-year-old man with a medical history of hypertension, dyslipidemia, and diabetes was referred to our hospital for effort angina. Coronary angiography revealed chronic total occlusion (CTO) of the proximal right coronary artery (RCA) that had been collateralized by septal branches from the left anterior descending coronary artery, left circumflex coronary artery, and an antegrade bridge. Three everolimus-eluting stents (Xience-Alpine: 3.0 × 38 mm, 2.75 × 38 mm, and 2.5 × 38 mm; Abbott-Vascular Co., Abbott Park, IL, USA; Fig. 1D, indicated by yellow lines) were implanted with stent overlap. Post-procedural angiography showed double-barrel flow through the RCA. Repeat angiography after 10 months showed double-barrel flow through the RCA, the stented lumen, and the non-stented lumen. Optical coherence tomography (OCT) demonstrated subintimal stenting. OCT revealed that the entry point from the true lumen (TL) was the proximal segment of the RCA, and the re-entry point to the TL was the distal segment of the RCA. Additionally, OCT showed smooth and thin neointimal proliferation inside the deployed stent, and there was no evidence of an intraluminal thrombus. To the best of our knowledge, this is the first report describing a subintimal stenting of CTO lesion involved with double-barrel coronary artery with OCT assessment.
authors.affiliation: Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan. Electronic address: yuwatanabe0808@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Ishiguro
authors.affiliation: Interventional Cardiology Unit, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus
keywords: Chronic total occlusion; Double-barrel; Subintimal stenting