Korean Circ J.  2014 Mar;44(2):113-117. 10.4070/kcj.2014.44.2.113.

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

• Rahman A
• Islam AM

• KMID: 2223900
• DOI: http://doi.org/10.4070/kcj.2014.44.2.113

Abstract

With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach.

Keyword

Angina, unstable; Percutaneous coronary intervention; Elderly

MeSH Terms

Aged
Aged, 80 and over
Angina, Unstable
Coronary Artery Disease
Humans
Life Expectancy
Mortality
Myocardial Revascularization
Percutaneous Coronary Intervention*
Registries

Figure

• 

  Fig. 1 Pre and post-procedure resting 12-lead ECG. A: admission ECG showing ST depression and T inversion in leads V 5, V 6, I and aVL, and ST elevation in aVR. B: ECG after the procedure showing near normalization of previous findings. ECG: electrocardiogram.

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  Fig. 2 Coronary angiogram before PCI. A: 75% stenosis in distal LMCA, 95% stenosis in proximal LMCA and 75% stenosis in mid segments of the left anterior descending artery, 75% osteo-proximal and 90% distal stenosis in left circumflex artery. B: total occlusion of right coronary artery from the origin. PCI: percutaneous coronary intervention, LMCA: left main coronary artery.

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  Fig. 3 Percutaneous coronary intervention in the unprotected left main coronary artery. A: kissing balloon inflation. B and C: Thrombolysis in Myocardial Infarction III flow without any residual stenosis.

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