STRATEGIJA REVASKULARIZACIJE BOLESNIKA SA KRITIČNIM SUŽENJEM GLAVNOG STABLA LEVE KORONARNE ARTERIJE U AKUTNOM KORONARNOM SINDROMU UDRUŽENIM SA HRONIČNOM TOTALNOM OKLUZIJOM DESNE KORONARNE ARTERIJE
Sažetak
Kritična stenoza glavnog stabla leve koronarne arterije u akutnom infarktu miokarda, praćena kardiogenim šokom, uz hroničnu totalnu okluziju desne koronarne arterije, predstavlja najkompleksniju situaciju za interventnog kardiologa. Urgentna revaskularizacija, hirurška ili perkutana, neophodna je. U našem slučaju, bolesnik muškog pola star 46 godina prezentovan je sa slikom infarkta miokarda bez ST elevacije, praćenog kardiogenim šokom. Hitnom koronarografijom uočena je kritična bifurkaciona stenoza distalnog glavnog stabla leve koronarne arterije i hroničnu totalnu okluziju desne koronarne arterije. Odluka je bila da se uradi intervencija iz dva dela, hitna intervencija na glavnom stablu leve koronarne arterije, a potom za šest meseci rekanalizacija desne koronarne arterije. Na osnovu koronarne anatomije, odluka je bila da se uradi TAP (T and protrusion) tehnika za glavno stablo leve koronarne arterije. Rekanalizacija desne koronarne arterije urađena je nakon šest meseci retrogradnim pristupom preko leve koronarne arterije.
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