Intravascular ultrasound-guided dissection recanalization in a patient with ST-segment elevation myocardial infarction: a case report. Issue 4 (4th April 2023)

• Record Type: Journal Article
• Authors: Sangen, Hideto; Wakita, Masaki; Toguchi, Riku; Tanaka, Kunio
• Editors: Kotronias, Rafail; Cader, F Aaysha; Kalogeropoulos, Andreas; Vervaat, Fabienne; Messiha, Daniel; Tsaban, Gal; Jathanna, Nikesh
• Is Part Of: European heart journal. Volume 7:Issue 4(2023)
• Publication Date: 2023-04-04
• Subjects: Coronary intervention -- ST-segment elevation myocardial infraction -- Antegrade dissection rewiring -- IVUS-guided tip detection -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytad172
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: In primary percutaneous coronary intervention (PCI) for acute myocardial infarction, we occasionally experience challenging cases where conventional guidewires cannot pass through the lesion. In such cases, if the use of a tapered guidewire or polymer jacket guidewire is also unsuccessful, coronary artery bypass surgery becomes inevitable. Therefore, other methods to enable revascularization in a reliable and timely manner are desirable. Case summary: We present the first case of intravenous ultrasound (IVUS)-guided tip detection (TD)-antegrade dissection re-entry (ADR) in a 73-year-old man who suffered ST-segment elevation myocardial infarction (STEMI). The patient had a total thrombotic occlusion of the right coronary artery and stenotic lesion of the left anterior descending artery. Primary PCI was unsuccessful and IVUS-guided rewiring using a chronic total occlusion (CTO) wire failed due to thrombus attenuation. However, IVUS imaging revealed the presence of intimal and subintimal space, which led us to perform IVUS-guided TD-ADR using Conquest Pro 12 ST (Asahi Intecc). Using the TD method, we were successful in swiftly puncturing the true lumen wall, and a stent was implanted following successful re-entry. Final angiography showed the establishment of Thrombolysis in Myocardial Infraction-3 flow and resolution of ST-segment elevation. Discussion: IVUS-guided TD enables accurate puncture in an ADR procedure, enabling successful recanalization in a relatively short time. Thus, IVUS-guided TD-ADR is a reliable option for revascularization in STEMI cases wherein the guidewire fails to pass the occlusion using conventional techniques.