Fracture and Plastering of Distal Left Main Stent During Double-kissing Culotte Technique: a Case Report

Overview

Journal Eur Heart J Case Rep

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2024 May 17

PMID 38756546

Authors

Saibal Mukhopadhyay

Ghazi Muheeb

Jamal Yusuf

Sanjeev Kathuria

Affiliations

Soon will be listed here.

Abstract

Background: Acute fracture of a left main (LM) stent during angioplasty is a rare complication. Cardiologists should be aware of the risk of stent fracture (SF) following kissing balloon inflation (KBI) even if the effective diameter of the balloons does not exceed the recommended expansion limits of stents.

Case Summary: A 64-year-old female with hypertension and dyslipidaemia presented with crescendo angina since three months in spite of optimal medical therapy. Coronary angiogram showed a distal LM bifurcation lesion. The patient was admitted for LM bifurcation stenting by upfront two-stent technique (inverted double-kissing Culotte technique). Following first KBI of the stent placed from left circumflex artery (LCX) to LM, there was stent deformation in the LM shaft. As we had planned the Culotte technique, we decided to exclude the fractured segment by stenting from left anterior descending artery (LAD) to LM. The stent from LAD-LM successfully excluded the fractured part of the first stent from the lumen of LM. Optical coherence tomography done after final KBI from LCX-LM revealed successful exclusion of the deformed segment of the LCX stent with mild malapposition at the site of the deformed stent. A follow-up angiogram after six months showed normal in-stent flow with no evidence of restenosis or pseudoaneurysm.

Discussion: Acute LM SF during coronary intervention can occur even if the effective cumulative diameter of the inflated balloons does not exceed the mentioned expansion limit of stents. Intravascular imaging is a helpful modality to define type of SF and its management.

Citing Articles

Optimal management of left main bifurcation disease with two-stent strategy.

Uysal H, Guner A, Uzun F Eur Heart J Case Rep. 2024; 8(7):ytae306.

PMID: 38993372 PMC: 11237886. DOI: 10.1093/ehjcr/ytae306.

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