Percutaneous intervention for ostial stenosis of left main coronary artery after modified Bentall–Piehler procedure

Excerpt

A 64-year-old man was admitted to our hospital with acute myocardial infarction (AMI). He had undergone a modified Bentall procedure with prosthetic aortic valve replacement (Carbomedics Carbo-Seal^®, LivaNova, London, UK; 25 mm) and Piehler operation with graft (Gelweave™, Vascutek Ltd, Glasgow Scotland; 8 mm) for acute aortic dissection (Stanford A) at age 53 years. Coronary angiography (CAG) showed post-anastomotic left main (LM) ostial stenosis (Fig. 1a). In view of the high risk of a re-operation in AMI, we performed percutaneous coronary intervention (PCI). Intravascular ultrasonography revealed a fibrous plaque covering the entire circumference of the native vessel, and the artificial graft could not be sufficiently visualized. We placed a 3.5 × 14 mm BMX-J^® stent (Cordis, Tokyo, Japan) (Fig. 1b–d) and post-dilated the graft lesion using a 6.0 × 15 mm NC Emerge™ balloon catheter (Boston Scientific, Marlborough, MA), both inflated to the rated pressure (Fig. 1e), resulting in a thrombolysis in myocardial infarction grade 3 flow (Fig. 1f). The patient was discharged seven days after PCI. A follow-up CAG after 3 months showed no re-stenosis. One year post-PCI, the patient was asymptomatic.

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