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Provisional Technique for Bifurcation Left Main In-Stent Restenosis Lesion: A Case Report

Heart Science Journal · Vol. 3 No. 4 (2022) · hlm. 21–28

DOI
10.21776/ub.hsj.2022.003.04.5
ISSN
2721-9984, 2721-9976
Terbit
2022-11-14
Penerbit
Universitas Brawijaya
Bahasa
en

Abstrak

BackgroundPercutaneous coronary intervention for bifurcation lesions remains challenging because of its complexity and the lack of trials to guide decision-making. Interventional cardiologists are forced to make decisions based on their own judgment and experience rather than the results of rigorously randomized trials.Case SummaryA 64-year-old male with some coronary risk factors of hypertension, passive smoker, and family history of CAD presented with recurring exertional chest pain for the last 4 months. He was hospitalized to undergo DCA-Adhoc after the ECG stress test revealed a positive result. The coronary angiography revealed a 95% ISR in the osteal LAD and 20% ISR of the proximal LCx. Since the patient refused to undergo coronary bypass surgery, the team decided to perform catheter intervention to the LM bifurcation of LAD-LCx. The procedure begins with the insertion of IABP through the access of the left femoral artery. We performed a provisional approach with the main vessel stenting of LM-LAD. At the end of the procedure, we performed simultaneous kissing balloon inflation of LAD-LCx followed by POT in LM stent as the post-dilation procedure.DiscussionWhen considering intervention on a bifurcation lesion, there are two general strategies i.e the more conservative or provisional technique that intent to only use one stent and the two-stent approach. The provisional technique is considered to offer advantages in terms of reducing procedure complexity, reducing fluoroscopic time, requiring less contrast volume, and reducing resource (stent) use compared by 2 stent strategy.

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Mohammad Saifur RohmanAfiliasi tidak diketahui39
Cholid Tri TjahjonoAfiliasi tidak diketahui29
Ardian RizalAfiliasi tidak diketahui23
Anna Fuji RahimahAfiliasi tidak diketahui22
Djanggan SargowoAfiliasi tidak diketahui20
Setyasih AnjarwaniAfiliasi tidak diketahui19
Indra PrasetyaAfiliasi tidak diketahui18
Heny MartiniAfiliasi tidak diketahui10
Putri Annisa KamilaUniversity of Brawijaya7
Seprian WidasmaraAfiliasi tidak diketahui5
Dea Arie KurniawanAfiliasi tidak diketahui5
Muhammad Rizki FadlanAfiliasi tidak diketahui5
Adhika Prastya WikanandaAfiliasi tidak diketahui4
Yoga WaranugrahaAfiliasi tidak diketahui4
Nikhen NoverikeAfiliasi tidak diketahui4
Imam Mi'raj SuprayogaAfiliasi tidak diketahui4
Sawitri SatwikajatiAfiliasi tidak diketahui3
Harris KristantoAfiliasi tidak diketahui3
Dyah Ayu IkeningrumAfiliasi tidak diketahui3
Evit RuspionoAfiliasi tidak diketahui3
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Bayu AjiAfiliasi tidak diketahui3
Tonny AdriyantoAfiliasi tidak diketahui2
Irma KameliaAfiliasi tidak diketahui2
Oktafin Srywati PamunaAfiliasi tidak diketahui2
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Dedy IrawanAfiliasi tidak diketahui2
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Ratna PancasariAfiliasi tidak diketahui2
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Sumber metadata: OAI-PMH (metadata jurnal) https://heartscience.ub.ac.id/index.php/heartscience/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en">Provisional Technique for Bifurcation Left Main In-Stent Restenosis Lesion:  A Case Report</dc:title>
	<dc:creator xml:lang="en">Nugraha, Krishna Ari</dc:creator>
	<dc:creator xml:lang="en">Widito, Sasmojo</dc:creator>
	<dc:creator xml:lang="en">Satrijo, Budi</dc:creator>
	<dc:creator xml:lang="en">Kurnianingsih, Novi</dc:creator>
	<dc:subject xml:lang="en">bifurcation lesion</dc:subject>
	<dc:subject xml:lang="en">provisional technique</dc:subject>
	<dc:subject xml:lang="en">kissing balloon inflation</dc:subject>
	<dc:description xml:lang="en">BackgroundPercutaneous coronary intervention for bifurcation lesions remains challenging because of its complexity and the lack of trials to guide decision-making. Interventional cardiologists are forced to make decisions based on their own judgment and experience rather than the results of rigorously randomized trials.Case SummaryA 64-year-old male with some coronary risk factors of hypertension, passive smoker, and family history of CAD presented with recurring exertional chest pain for the last 4 months. He was hospitalized to undergo DCA-Adhoc after the ECG stress test revealed a positive result. The coronary angiography revealed a 95% ISR in the osteal LAD and 20% ISR of the proximal LCx. Since the patient refused to undergo coronary bypass surgery, the team decided to perform catheter intervention to the LM bifurcation of LAD-LCx. The procedure begins with the insertion of IABP through the access of the left femoral artery. We performed a provisional approach with the main vessel stenting of LM-LAD. At the end of the procedure, we performed simultaneous kissing balloon inflation of LAD-LCx followed by POT in LM stent as the post-dilation procedure.DiscussionWhen considering intervention on a bifurcation lesion, there are two general strategies i.e the more conservative or provisional technique that intent to only use one stent and the two-stent approach. The provisional technique is considered to offer advantages in terms of reducing procedure complexity, reducing fluoroscopic time, requiring less contrast volume, and reducing resource (stent) use compared by 2 stent strategy.</dc:description>
	<dc:publisher xml:lang="en">Universitas Brawijaya</dc:publisher>
	<dc:date>2022-11-14</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://heartscience.ub.ac.id/index.php/heartscience/article/view/1352</dc:identifier>
	<dc:identifier>10.21776/ub.hsj.2022.003.04.5</dc:identifier>
	<dc:source xml:lang="en">Heart Science Journal; Vol. 3 No. 4 (2022): Prevention, Screening dan Rehabilitation : The Back Bone of Quality Care Improvement in CVD Management; 21-28</dc:source>
	<dc:source>2721-9984</dc:source>
	<dc:source>2721-9976</dc:source>
	<dc:source>10.21776/ub.hsj.2022.003.04</dc:source>
	<dc:language>en</dc:language>
	<dc:relation>https://heartscience.ub.ac.id/index.php/heartscience/article/view/1352/244</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2022 Krishna Ari Nugraha, Sasmojo Widito, Budi Satrijo, Novi Kurnianingsih</dc:rights>
</oai_dc:dc>