2022 Volume 86 Issue 2 Pages 336-
A 70-year-old woman was referred because of non-ST-elevation myocardial infarction. Because urgent coronary angiography (CAG) showed ostial stenosis in the left circumflex artery (Figure A), we subsequently performed optical coherence tomography (OCT) imaging to assess lesion morphology; a calcified nodule (CN) with white thrombus was found in the ostial stenosis (Figure B). To avoid crossover stenting, we decided to perform stent-less percutaneous coronary intervention (PCI) for the ostial stenosis. After rotational atherectomy using a 1.5-mm burr, predilatation by scoring balloon (NSE ADVANCE 3.0×13 mm, NIPRO, Osaka, Japan) was performed, followed by drug-coated balloon angioplasty (SeQuent please 3.0×15 mm, B Braun, Melsungen, Germany). Finally, good vessel expansion (>4.9 mm2) was obtained without major coronary dissection (Figure C,D; Supplementary Movie 1). After 5 months, CAG and OCT revealed no restenosis or development of CN (Figure E,F; Supplementary Movie 2).
(A) Preprocedural coronary angiography (CAG) and (B) optical coherence tomography (OCT). (C) Post-procedural CAG and (D) OCT. (E) 5-month follow-up CAG and (F) OCT. Red arrows: culprit lesion. White arrow: calcified nodule. Dotted line: tissue ablated by rotational atherectomy.
It is reported that CN is related to poor clinical outcomes of stent implantation within several months,1 but the optimal strategy for CN has yet to be established. Although some case reports show the safety of stent-less PCI of stable CN lesions, this procedure for acute coronary syndrome (ACS)-related CN has never been reported. If sufficient luminal area can be obtained without major coronary dissection, stent-less PCI could be a therapeutic option even for CN causing ACS.
Y.M. is a member of Circulation Journal’s Editorial Team.
Supplementary Movie 1. Post-PCI OCT image.
Supplementary Movie 2. Follow-up OCT image.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-21-0628
