Abstract: Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization. Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access. Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration. Medical consilium decided to perform staged endovascular revascularization of the myocardium. For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used. Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis. Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.
Abstract: Aim: was to evaluate the safety and efficacy of delayed endovascular treatment without stent implantation in ST-elevation myocardial infarction (STEMI) caused by massive thrombotic load and ectasia of infarct-related coronary artery. Material and methods: out of 4263 primary percutaneous coronary interventions (PCI) performed for STEMI for the period from January 2016 to September 2021, retrospective analysis included data of 21 patients with ectasia of infarct-related coronary artery and massive thrombotic load (TTG ? 3). Results: method of delayed endovascular treatment, without stent implantation, in STEMI caused by massive thrombotic load and ectasia of infarct-related coronary artery, allowed to significantly improve parameters of epicardial coronary blood flow according to TIMI and CFTC scales in 71% and 67% of examined patients (p <0,001, p=0,001); increase myocardial perfusion according to MBG in 62% of patients (p=0,001); reduce the severity of thrombotic load according to TTG scale in 71% of the subjects (p=0,001). Conclusion: in patients with ST-elevation myocardial infarction caused by massive thrombotic load and ectasia of infarct-related coronary artery, the strategy of delayed endovascular treatment with-out stent implantation is safe and effective at the hospital stage.
