case_images: PMC11371707_01
case_images: Pre-operative electrocardiogram. Atrial fibrillation with moderate ventricular response accompanied by T wave inversion in V2-6, poor R wave progression and premature ventricular complex.
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case_images: F1
case_images: Laboratory tests indicated normal renal function, with a creatinine level of 0.55 mg/dl (normal range: 0.66-1.09 mg/dl), and a slightly elevated NT-proBNP concentration of 322 ng/L (normal range: <125 ng/L). (Figure 1) illustrates the patient's electrocardiogram (ECG) findings at the time of admission.
case_images: Results of the coronary angiography. (A) Dissection extending from the LM to the LCx (indicated by red arrow). (B-E) No significant stenosis observed in the LAD, RCA, Ao-vein-LAD, and Ao-vein-RCA. (F) Passage of the wire through both the LAD and the LCx, accompanied by an IVUS assessment.
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case_images: F2
case_images: Using a sion wire, the lesion in the distal LCx was successfully crossed, after which a sion blue wire was advanced towards the distal LAD (Figure 2).
case_images: IVUS images of the LMCA dissection.
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case_images: F3
case_images: The dissection angle measured at this site was 230 degrees (Figure 3).
case_images: The PCI procedure for the LMCA and the LCx. (A) Deployment of a DES in the LMCA-LCx. (B) Initial Proximal Optimization Technique (POT) in the LM using a NC balloon. (C) Subsequent rewiring and dilation of the LAD ostium with a NC balloon. (D) In-stent post-dilation. (E) Second POT in the LMCA. (F) Final angiographic result.
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case_images: F4
case_images: Post-procedure coronary angiography confirmed TIMI 3 flow in the LMCA and LCx (Figure 4).
case_images: IVUS measurements following LMCA-LCx PCI. (A) MSA of the distal reference. (B) Plaque burden and distal reference diameter. (C) MSA at the proximal LMCA. (D) MSA at the distal LMCA. (E) MSA at the ostium of the LCx. (F) Smallest MSA within the stent.
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case_images: F5
case_images: Additionally, IVUS verified adequate stent apposition at both proximal and distal ends (Figure 5).
case_images: Dynamics of blood lactate and bicarbonate (HCO3-) levels during hospitalization.
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case_images: F6
case_images: The patient's hemodynamics status and metabolic acidosis condition showed significant improvement post-procedure (Figure 6).