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Bifurkacni leze tvoři 15-20 % vsech intervenovaných koronarnich lezi a jejich osetřovani je i přes výrazný pokrok v intervencni kardiologii i nadale spojeno s technickými obtižemi a horsi klinickou efektivitou. Zakladnim doporucovaným postupem pro osetřovani bifurkacnich lezi je "provisional stenting". Jako alternativni postup lze zvažit některou z dvoustentových technik. V nasem registru jsme se rozhodli posoudit bezpecnost, technickou a klinickou uspěsnost při použiti dedikovaneho bifurkacniho stentu Tryton Side Branch. Do registru bylo zařazeno 201 pacientů neselektovane populace osetřených v obdobi mezi cervnem 2012 a dubnem 2016 v Kardiovaskularnim centru Krajske nemocnice Liberec, u kterých bylo zvažovano užiti bifurkacniho stentu Tryton. Uspěsnost osetřeni bifurkacnich lezi při užiti stentu Tryton byla 85,07 %. Pacienty jsme pote sledovali v obdobi sesti měsiců od osetřeni. K infarktu myokardu doslo u tři pacientů, k revaskularizaci bylo nutno přistoupit pouze u tři pacientů, z toho vsak ani jednou nebylo potřeba osetřit cilovou tepnu nebo lezi. Otazka osetřovani bifurkacnich lezi zůstava do budoucna stale otevřena, jako možna alternativa se jevi užiti dedikovaných bifurkacnich stentů. Bifurkacni stent Tryton ma výhodu v ochraně bocni větve, jejiž osetřeni může být u větsiny standardnich technik problematicke. Stent Tryton lze dle nasich dat s výhodou použivat zejmena u bifurkacnich lezi s velkou bocni větvi (≥ 2,5 mm). Data z naseho registru tak svědci pro vysokou bezpecnost a uspěsnost osetřovani tohoto typu bifurkacnich lezi pomoci stentu Tryton. © 2019, CKS.

We report the case of a patient with acute anterolateral myocardial infarction without ST segment elevations and incipient cardiogenic shock due to complex high grade left main (LM) stenosis and tight calcified ostial left anterior descending (LAD) artery stenosis. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. During 30 days follow-up, the patient remains stable. An acute interventional approach in unprotected LM coronary stenosis is associated with high procedural risk. Combining that procedure, i.e., rotational atherectomy, with stent placement enhanced procedural success and clinical outcome in this case.

Fig. 1 – Schema of the loop of the diagnostic catheter and procedures for its removal. Case report: A 76-year-old female presented with a history of intermittent chest pain at rest during the previous two days. She had no significant past medical history and was on no medication. Chest X-ray was unremarkable, but her 12-lead electrocardiogram revealed lateral ST depressions of 2 mm. Coronary angiography was performed via her right radial artery. The radial artery puncture was straightforward, and a TIG 5F catheter was used to attempt left coronary angiography. Unfortunately, while struggling to pass through the severe tortuosity of the brachiocephalic artery, the catheter made a loop high in the radial artery close to the brachial bifurcation. Despite gentle attempts to rotate the catheter to undo the kinking, the catheter became stuck in the artery due to spasm, and even gentle manipulation was very painful for the patient. A cocktail of nitroglycerin and verapamil was repeatedly administered intra-arterially, and this relieved the spasm. We were unable to cross through the kinked portion, even with a coronary guide wire. An attempt was made to snare the tip of the catheter with the coronary loop via the right femoral artery and straighten the catheter. This was unsuccessful due to the severe tortuosity of the brachiocephalic artery. We considered vascular surgery to remove the catheter. Prior to going to the surgical department, however, we decided to make one last attempt to straighten the catheter. We cut off the end of the catheter, removed the 6F