Instructive percutaneous coronary intervention to avoid the risk of side branch occlusion at a lesion with a lotus root appearance: a case report

Abstract

BackgroundA lotus root appearance is a rare entity, and there is little opportunity to perform coronary intervention for this kind of lesion. Because of its peculiar anatomical characteristics, one of the problems regarding percutaneous coronary intervention (PCI) for these lesions is related to the involvement of branch vessels.Case presentationWe encountered a case of PCI for a stenotic lesion with a lotus root appearance in the mid-portion of the right coronary artery (RCA). To avoid the risk of right ventricular (RV) branch occlusion due to stent deployment in the main RCA, we re-crossed the third guidewire into the main RCA via the nearest point to the RV branch ostium through the communicating vascular lumen. Thereafter, we deployed a drug-eluting stent in the main RCA crossing over the RV branch, and the ostium of the RV branch remained intact, as we expected.ConclusionsThis case is the first report in the world describing the details of how to maintain the patency of the side branch bifurcating from a lesion with a lotus root appearance under optical coherence tomography guidance.

Diagnosis and treatment of angiographically unclear coronary lesions

“…9 In both cases, most of the lumens are extremely small compared with the true lumen of the coronary artery proximal and distal to the site of the altered wall structure, and in many cases, they limit normal blood flow and require revascularization. 6,8,10…”

“…Additionally, non-atherosclerotic lesions are often unclear, which makes decisions regarding further treatment difficult. 2,5,6 Identifying non-atherosclerotic lesions in the pathogenesis of ischemic heart disease is important. It enables early risk assessment of complications and acute coronary events, determination of the constituent components of the lesions, elucidation of the pathophysiological mechanism of their origin, and administration of adequate treatment.…”

Lotus root‐like appearance in the left anterior descending artery treated with a drug‐coated balloon angioplasty

“…Nomura et al reported the usefulness of OCT‐guided stenting to maintain the patency of a side branch bifurcating from a lesion with a lotus root‐like appearance. 7 For lesions of this type, in order to avoid the occlusion of side branches by stenting, the use of a debulking device such as an excimer laser has been reported. 8 To prevent side branch occlusion, the side branches of the main LAD were dilated.…”

“…Percutaneous coronary intervention is inapplicable for these lesions due to its peculiar anatomical characteristics and the involvement of branch vessels. Nomura et al reported the usefulness of OCT‐guided stenting to maintain the patency of a side branch bifurcating from a lesion with a lotus root‐like appearance 7 . For lesions of this type, in order to avoid the occlusion of side branches by stenting, the use of a debulking device such as an excimer laser has been reported 8 .…”

Honeycomb-like structure in the right coronary artery treated with a drug-eluting stent: a case report and literature review

“…In total, 20 studies were evaluated. 1 – 20 The diagnosis of HLS was based on coronary intravascular imaging modalities such as intravascular ultrasound and OCT. OCT is the preferred tool with which to demonstrate detailed structures because of its high spatial resolution (10–15 µm). HLS could be found in all three epicardiac arteries without significant territory dominance.…”