Percutaneous Coronary Intervention for Double Ostial Lesion Presenting with ST-Segment Elevation Myocardial Infarction: Chronic Total Occlusion at Left Main Ostium and Plaque Rupture at Right Coronary Artery Ostium.

Abstract

https://doi.org/10.4068/cmj.2021.57.1.99 C Chonnam Medical Journal, 2021 Chonnam Med J 2021;57:99-101 Corresponding Author: Youngkeun Ahn Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-4764, Fax: +82-62-224-4764, E-mail: cecilyk@hanmail.net Article History: Received May 20, 2020 Revised July 12, 2020 Accepted July 21, 2020 FIG. 1. The initial 12-lead electrocardiogram showed ST-segment elevation on inferior leads (G). Emergent coronary angiography revealed critical stenosis at the right coronary artery ostium (A, arrow) with grade III collateral flow (A-C, dotted line) to left main ostium (D, arrow head). The left main ostium was not found by a Judkins left diagnostic catheter. Intravascular ultrasound (IVUS) was done for target lesions for the right coronary artery (RCA; E, arrow) which revealed a large amount of plaque with plaque rupture (minimal lumen area 3.9 mm 2 and plaque burden 73.9%). Percutaneous coronary intervention was done for the RCA using a 4.5×15 mm durable polymer drug-eluting stent, and follow-up coronary angiography (F, arrow head) with IVUS showed good distal flow with good stent apposition. Percutaneous Coronary Intervention for Double Ostial Lesion Presenting with ST-Segment Elevation Myocardial Infarction: Chronic Total Occlusion at Left Main Ostium and Plaque Rupture at Right Coronary Artery Ostium