Key result
A patient with chronic dialysis and a calcified left main true bifurcation lesion underwent staged PCI and minimally invasive direct CABG, but died of non-occlusive mesenteric ischemia.
Why the study?
The optimal coronary revascularization strategy for anatomically complex coronary artery lesions in chronic hemodialysis patients remains controversial, and no guidelines currently address this setting.
Case Report (n=1)
This case highlights the complexity and high risk of revascularization strategies in patients with chronic hemodialysis and severely calcified left main bifurcation lesions.
Answers are grounded in this paper and cite their sources.
Substantial mortality risk with staged PCI-MIDCAB in dialysis patients with calcified LM lesions; leaves optimal revascularization approach unresolved.
Previous observational studies and meta-analyses reported that the optimal strategy of coronary revascularization (percutaneous coronary intervention [PCI] and bypass surgery) for anatomically complex coronary artery lesions in the chronic hemodialysis setting is still controversial because the long-term outcomes were superior with coronary artery bypass grafting, especially with regard to repeat revascularization; however, short-term mortality with PCI was significantly lower because it is less invasive. Moreover, no guidelines show a strategy for this setting. We report the case of a patient with chronic dialysis and calcified left main true bifurcation lesion who underwent staged PCI with rotational atherectomy and minimally invasive direct coronary artery bypass for in-stent restenosis who died of non-occlusive mesenteric ischemia.
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Dan et al. (2020) conducted a case report in Chronic dialysis and calcified left main true bifurcation lesion (n=1). Staged percutaneous coronary intervention with rotational atherectomy and minimally invasive direct coronary artery bypass was evaluated. A patient with chronic dialysis and a calcified left main true bifurcation lesion underwent staged PCI and minimally invasive direct CABG, but died of non-occlusive mesenteric ischemia.
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