Kardiyojenik Şok Tablosunda Gelen Sol Ana Koroner Lezyonu Olan Hastaya Başarılı Perkütan Koroner Girişim
Özet
Bu olgu sunumunda, kardiyojenik şok tablosunda acil servise getirilen, elektrokardiyografisinde (EKG) aVR derivasyonunda 3 mm ST elevasyonu ve yaygın ST depresyonu saptanan 85 yaşında bir kadın hastanın başarılı perkütan koroner girişim (PCI) süreci aktarılmaktadır. Özgeçmişinde hipertansiyon ve yoğun sigara kullanımı olan hastaya yapılan koroner anjiyografide, sol ana koroner arter (LMCA) distalinden başlayıp sol ön inen arter (LAD) ostealine uzanan %98 darlık oluşturan trombüslü lezyon ve sol sirkümfleks arterin (LCx) ostealinden itibaren total tıkalı olduğu görülmüştür. Norepinefrin ve ikili antiplatelet desteğiyle kateter laboratuvarına alınan hastaya, Culotte tekniği kullanılarak başarılı bir LAD-LCx bifurkasyon PCI işlemi uygulanmıştır. Müdahalede ilk olarak LMCA'dan LAD'ye ilaç salınımlı stent yerleştirilmiş, ardından LMCA'dan LCx'ye ikinci bir stent uygulanarak "Final Kissing Baloon" ve POT işlemleriyle tam açıklık sağlanmıştır. İşlem sonrasında hemodinamisi düzelen ve komplikasyon gelişmeyen hasta, üç günlük takibin ardından şifayla taburcu edilmiştir. Akut LMCA tıkanıklıklarında hastane içi mortalite oranları %60 civarında seyretmekte ve hastaların büyük kısmı laboratuvara ulaşamadan hayatını kaybetmektedir. Bu vakadaki başarılı sonuç, erken tanı ve zamanında yapılan doğru girişimsel müdahalenin önemini bir kez daha ortaya koymaktadır.
This case report presents a successful percutaneous coronary intervention (PCI) in an 85-year-old female patient who presented to the emergency department in cardiogenic shock, with an electrocardiogram (ECG) showing 3 mm ST elevation in lead aVR and widespread ST depression. The patient, who had a history of hypertension and heavy smoking, underwent coronary angiography which revealed a thrombus-containing lesion causing 98% stenosis extending from the distal left main coronary artery (LMCA) to the ostial left anterior descending artery (LAD), along with a totally occluded left circumflex artery (LCx) from its ostium. Following the initiation of norepinephrine and dual antiplatelet therapy, the patient was taken to the catheterization laboratory, where a successful LAD-LCx bifurcation PCI was performed using the Culotte technique. The procedure involved deploying a drug-eluting stent from the LMCA to the LAD, followed by a second stent from the LMCA to the LCx, achieving complete patency through Final Kissing Balloon and POT optimization. Post-procedurally, the patient’s hemodynamics stabilized, no complications occurred, and she was successfully discharged after three days of monitoring. Given that in-hospital mortality remains around 60% for acute LMCA occlusions, this case underscores that early recognition and timely intervention are crucial for survival.
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