Two-staged stent-assisted angioplasty treatment strategy for severe left main coronary distal bifurcation stenosis associated with the right coronary chronic total occlusion.

A 63-year-old female patient, with history of 8-year hypertension and 10-year hyperlipidemia, presented with severe left main coronary bifurcation stenosis (LMCS) associated with the right coronary artery chronic total occlusion (CTO-RCA). On the day of admission, she received drug treatment with aspirin, clopidogrel, heparin, statins, angiotensin converting enzyme inhibitors and β-blocker. On the next day, she underwent CTO recanalization with 6F guiding-catheter and two rapamycin-eluting stents, and showed no postoperative discomfort after interventional treatment. Considering having hypertensive nephropathy and chronic renal insufficiency, the patient then received intravenous saline full hydration therapy. Two weeks after successful completion of the RCA revascularization, the original collateral circulation in the blood flow from the LMC to RCA became two-way flow. Under the safe and reliable protective condition, staged percutaneous coronary intervention (PCI) with 6F XB3.0 guiding catheter and rapamycin-eluting stents was applied to treat the LMCL. 9-month postoperative follow-up with coronary computed tomographic imaging showed no restenosis inside the original stent, without any myocardial ischemic event. Our successful approach to turn the original unprotected LMCS combined with CTO-RCA into a protective one reduces the interventional risk and provides additional option besides coronary artery bypass graft surgery to treat such complex coronary artery disease (CAD).