Anterior STEMI Ana Koroner Arter Bifurkasyon Lezyonun DK-Crush Tekniği İle Stentlemesi
Özet
Bu olgu sunumunda, anterior ST yükselmeli miyokard infarktüs (STEMI) ile başvuran 65 yaşındaki erkek hastada görülen kompleks ve kalsifik sol ana koroner arter (SAK) bifürkasyon lezyonu ele alınmıştır. Hastada SAK distalinde ciddi darlık ile birlikte sol inen arter (LAD) ve sirkumfleks arter (Cx) ostiumlarını tutan Medina sınıfı 1,1,1 tipinde kompleks bifürkasyon lezyonu saptanmıştır. Acil perkütan koroner girişim sırasında DK Crush (Double Kissing Crush) tekniği uygulanmış ve başarılı revaskülarizasyon sağlanmıştır. Özellikle SAK bifürkasyon lezyonlarında DK Crush tekniğinin; tam yan dal ostial kapsama sağlaması, düşük restenoz oranı ve uzun dönem majör kardiyak olayları (MACE) azaltması nedeniyle avantajlı olduğu belirtilmiştir. DK Crush çalışmaları başta olmak üzere birçok araştırmada bu tekniğin culotte ve provisional stentleme yöntemlerine üstün olduğu gösterilmiştir. Deneyimli operatörler tarafından uygulandığında DK Crush tekniğinin STMI ile prezente olan kompleks SAK bifürkasyon lezyonlarında hızlı, güvenli ve etkili bir tedavi seçeneği olabileceği anlatılmaktadır.
This case report presents a complex and calcified left main coronary artery (LMCA) bifurcation lesion in a 65-year-old male patient presenting with an anterior ST-segment elevation myocardial infarction (STEMI). The patient was diagnosed with a Medina 1,1,1 complex bifurcation lesion characterized by severe stenosis in the distal LMCA, extending into the ostia of both the left anterior descending (LAD) and circumflex (Cx) arteries. During the emergent percutaneous coronary intervention (PCI), the Double Kissing (DK) Crush technique was performed, achieving successful revascularization. The DK Crush technique is particularly advantageous for LMCA bifurcation lesions, as it provides complete ostial coverage of the side branch, demonstrates a low restenosis rate, and reduces the incidence of long-term major adverse cardiac events (MACE). Numerous studies, most notably the DKCRUSH trials, have demonstrated the superiority of this technique over both culotte and provisional stenting strategies. Ultimately, this report highlights that when performed by experienced operators, the DK Crush technique serves as a rapid, safe, and highly effective treatment option for complex LMCA bifurcation lesions presenting in the setting of STEMI.
Referanslar
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