A planned hybrid culotte stenting procedure in the setting of an acute STEMI

Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York 10305, USA.
Cases Journal 11/2009; 2(11):9104. DOI: 10.1186/1757-1626-2-9104
Source: PubMed


Bifurcation lesions have traditionally presented a unique problem for interventional cardiologists because of their inherent anatomy and risk of closure of the side branch, after a percutaneous intervention for the primary lesion of the main branch.
We report the case of a 57-year-old man who presented with acute ST-segment elevation myocardial infarction secondary to a 100% occlusion at the ostium of first diagonal (D1) branch. Patient also had a 70% stenosis of the mid-segment of the left anterior descending (LAD) coronary artery at the D1 branching point (1,1,1 Medina classification). A bare metal stent (BMS) was deployed at the site of the culprit lesion in the D1, while a drug eluting stent (DES) was placed in the LAD. We believe that the BMS at the culprit thrombotic, inflamed site in D1 is more likely to re endothelialize than a DES and the DES in the LAD, is less likely to re-stenose than a BMS.
This is the only reported case, where in the setting of an acute ST elevation myocardial infarction, a hybrid Culotte technique was successfully performed with excellent long-term results, thus achieving an acceptable balance of risks between restenosis (in the case of a BMS) and stent thrombosis (in the case of a DES).

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