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Image in Cardiology
Optical coherence tomography-guided V-stenting in the distal left main
V-stenting no tronco distal guiado por tomografia de coerência ótica
André Luz
Autor para correspondência
andrecoimbraluz@hotmail.com

Corresponding author.
, João Silveira, Fernando Araújo, Susana Ruivo, Henrique Carvalho, Severo Torres
Serviço de Cardiologia, Centro Hospitalar do Porto, E.P.E., Porto, Portugal
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pullbacks from &#40;A&#41; left anterior descending &#40;LAD&#41; and &#40;B&#41; left circumflex &#40;LCx&#41; arteries with 3D reconstruction&#59; &#40;C&#41; distal left main &#40;LM&#41; before LAD and LCx ostia showing no significant stenosis &#40;area 12 mm<span class="elsevierStyleSup">2</span>&#41;&#46; Carina with &#8220;eyebrow&#8221; shape&#44; leading to plaque shift &#40;see also <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; &#42;&#58; carina&#59; &#42;&#42;&#58; marginal branch&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old man with hypertension&#44; bilateral carotid disease&#44; porcelain aorta and moderate renal failure was admitted with non-ST-elevation myocardial infarction&#46; Coronary angiography revealed three-vessel disease with distal left main &#40;LM&#41; bifurcation involving the ostia of both the left anterior descending &#40;LAD&#41; and the left circumflex &#40;LCx&#41; coronary arteries &#40;Medina 0&#44;1&#44;1&#59; SYNTAX score 23&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The patient was considered unsuitable for surgery&#46; Optical coherence tomography &#40;OCT&#41;-guided percutaneous coronary intervention &#40;PCI&#41; was undertaken&#46; Pullbacks from the LAD and LCx &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; were obtained using frequency-domain OCT &#40;ILUMIEN OPTIS PCI Optimization System&#44; St&#46; Jude Medical&#44; St&#46; Paul&#44; MN&#41;&#46; The OCT findings confirmed proximal LAD and LCx stenosis with ostial involvement&#44; without significant disease in the LM&#46; Moreover&#44; the carina showed the &#8220;eyebrow&#8221; sign&#44; indicating a risk of plaque shifting&#46; Non-simultaneous V-stenting of both LAD and LCx was the chosen technique&#46; After stenting the LAD &#40;3&#46;0&#47;38 mm drug-eluting stent&#41;&#44; plaque shifting to the LCx was evident on coronary angiography &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A&#41;&#46; A 3&#46;5&#47;16 mm drug-eluting stent was implanted in the LCx&#44; with final kissing balloon &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>B&#41;&#46; Pullback with real-time 3D reconstruction from the LCx revealed the V-stenting with correctly apposed struts and protruding only slightly into the LM &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">OCT-guided PCI in the LM is under-reported as compared to intravascular ultrasound &#40;IVUS&#41; and there are ongoing discussions as to whether OCT can replace IVUS in this setting&#46; This case illustrates how OCT with its high resolution combined with real-time 3D reconstruction can be used to influence the approach to be chosen and to evaluate the final result&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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