scholarly journals Simultaneous stenting of the left main coronary stem and internal carotid artery in a hemodynamically unstable patient

2011 ◽  
Vol 68 (8) ◽  
pp. 712-715 ◽  
Author(s):  
Dragan Sagic ◽  
Zelimir Antonic ◽  
Milan Stanisic ◽  
Nenad Ilijevski ◽  
Predrag Milojevic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenting ◽  
Main Stem ◽  
Left Main ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Unstable Patient ◽  
Left Main Stem ◽  
The Right

Introduction. Combined endovascular interventions on carotid and coronary arteries are rare. Stenting of the unprotected coronary left main stem is a high risk procedure. We presented hemodynamically unstable patient with combined carotid artery and left main stem coronary artery stenting. Case report. A 78-year-old female patient was admitted to our institution for right carotid endaterectomy. The patient had 80% stenosis of the right carotid artery and occlusion of the left carotid artery. Coronary angiography revealed 70% ostial left main stenosis, occlusion of the right coronary artery and the left circumflex artery, and 80% stenosis of the left anterior descending artery. Simultaneous carotid artery endaterectomy and coronary artery by-pass grafting were considered. Due to high perioperative risk, surgery was rejected, and the patient was treated endovascularly with stenting of arteries occluded. The procedure was completed without complications and the patient was hemodynamically stabilised. Conclusion. This report illustrates simultaneous coronary and carotid stenting as a successfull lifesaving procedure.

scholarly journals Frequency of significant carotid artery disease on carotid angiography in patients with left main stem coronary artery disease.

2021 ◽  
Vol 28 (09) ◽  
pp. 1252-1256
Author(s):  
Aatar Yaqoob ◽  
Sonia William ◽  
Muhammad Yasir
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Main Stem ◽  
Carotid Angiography ◽  
Left Main ◽  
Arterial Access ◽  
Left Main Stem ◽  
Artery Disease

Objectives: To determine the frequency of significant carotid artery disease on carotid angiography in patients presenting with left main stem coronary artery disease. Study Design: Cross Sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to April 2017. Material & Methods: 140 patients were included in this study. To diagnose carotid artery disease, carotid angiography was performed. Imaging was performed while subjects were lying in a supine position. Arterial access gained through femoral artery and using Headhunter carotid angiography catheter (6F). Lateral, AP and ipsilateral oblique views was obtained. Results: Age ranges between 40-75 years with mean age of 53.91±7.05 years. There were 94 (67.2%) male patients while remaining 46 patients (32.8%) were female. Carotid artery disease was found in 54 patients (38.6%). Stratification with regard to gender and age was carried out. Conclusion: In conclusion, frequency of carotid artery disease in patients with left main stem coronary artery disease is high in our population. Therefore, screening of carotid artery disease should be recommended in patients with CAD, especially in older patients with multivessel CAD.

scholarly journals Angiographic Severity of Coronary Artery Disease in Diabetic and Non-Diabetic Patients in a Tertiary Care Centre

2015 ◽  
Vol 10 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Tanjima Parvin ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
SM Ahsan Habib ◽  
Mukhlesur Rahman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Main Stem ◽  
Diabetic Patients ◽  
Left Main ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Severe Coronary Artery ◽  
Artery Disease

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience

2009 ◽  
Vol 17 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Raja Parvez Akhtar ◽  
Mumraiz Salik Naqshband ◽  
Abdul Rehman Abid ◽  
Zafar Tufail ◽  
Abdul Waheed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Main Stem ◽  
Hospital Death ◽  
Left Main ◽  
Total Occlusion ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Ischemic Attack

Chronic total occlusion of the left main stem coronary artery is rare. This retrospective study was conducted to evaluate outcomes of coronary artery bypass grafting between June 1998 and June 2008 in patients with chronic left main stem total occlusion. There were 17 (0.025%) cases detected in 67,082 coronary angiograms. The 14 men and 3 women had a mean age of 55.32 ± 9.2 years. Risk factors included diabetes in 8, hypertension in 6, and smoking in 6. Of 54 grafts applied, 15 were arterial and 39 were venous; 14 patients had 3-vessel disease, and 3 had 4-vessel disease. Three patients required intraaortic balloon counterpulsation perioperatively. The mean intensive care unit stay was 2.1 ± 1.2 days, and hospital stay was 7.1 ± 1.5 days. Postoperatively, one patient suffered myocardial infarction, another had a transient ischemic attack with spontaneous recovery, and 2 developed atrial fibrillation. There was no operative or hospital death. Surgical revascularization is considered appropriate treatment for chronic total occlusion of the left main stem.

scholarly journals Variations in the Left Coronary Artery

2017 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Sultana Ruma Alam
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Artery Bypass ◽  
Clinical Manifestations ◽  
Coronary Arteriography ◽  
Ascending Aorta ◽  
Main Stem ◽  
Aortic Sinus ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1. These variations mainly occur in the Left Coronary Artery (LCA)2. While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual3. Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies.Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers.Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed.Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 42-47

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