{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T21:21:39Z","timestamp":1775251299549,"version":"3.50.1"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Optimal strategy for treating bifurcation lesions or lesions with large thrombus in left main disease remains elusive. Excimer laser coronary angioplasty (ELCA) is a therapeutic option for thrombotic lesions in acute coronary syndrome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 68-year-old man with chest pain was transferred to our emergency department, and subsequently diagnosed as inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed a 75% stenosis in the left main trunk (LMT). Optical coherence tomography (OCT) showed massive thrombus at the distal LMT to the ostial left anterior descending artery (LAD) and left circumflex artery (LCx). ELCA was performed in the three directions from LMT to proximal LAD, proximal LCx, and obtuse marginal branch. OCT after ELCA showed reduction of thrombus and no apparent plaque rupture or calcification, implying that coronary thrombosis was caused by OCT-defined plaque erosion. Intracoronary electrocardiogram of the LCx showed ST-segment elevation which corresponded to inferior ST-segment elevation, whereas no intracoronary electrocardiogram ST-segment elevation was detected for LAD. Taking all of the data including angiographic appearance, OCT-derived residual lumen size and residual thrombus volume, and strategic options into consideration, we completed percutaneous coronary intervention without stent deployment. He has been free from any cardiac events thereafter for 8\u2009months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Optimal strategy of coronary intervention for bifurcation lesions, especially LMT bifurcations, remains elusive. ELCA may have a potential to safely reduce intracoronary thrombus in patients presenting with acute coronary syndrome with OCT guidance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa003","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T09:03:13Z","timestamp":1581325393000},"page":"1-6","source":"Crossref","is-referenced-by-count":7,"title":["Primary percutaneous coronary intervention for a left main bifurcation lesion without stenting using excimer laser with optical coherence tomography guidance: a case report"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1499-9188","authenticated-orcid":false,"given":"Masahiro","family":"Hada","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Ohtsuno, Tsuchiura, Ibaraki 300-0028, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyo","family":"Sugiyama","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Ohtsuno, Tsuchiura, Ibaraki 300-0028, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihisa","family":"Kanaji","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Ohtsuno, Tsuchiura, Ibaraki 300-0028, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsunekazu","family":"Kakuta","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Ohtsuno, Tsuchiura, Ibaraki 300-0028, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"2020022804011919400_ytaa003-B1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"2020022804011919400_ytaa003-B2","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.jcin.2018.03.009","article-title":"Long-term clinical outcomes and optimal stent strategy in left main coronary bifurcation stenting","volume":"11","author":"Cho","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"2020022804011919400_ytaa003-B3","doi-asserted-by":"crossref","first-page":"e007007","DOI":"10.1161\/CIRCINTERVENTIONS.118.007007","article-title":"Outcomes among patients undergoing distal left main percutaneous coronary intervention","volume":"11","author":"Kandzari","year":"2018","journal-title":"Circ Cardiovasc Interv"},{"key":"2020022804011919400_ytaa003-B4","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.jcin.2014.05.012","article-title":"Intracoronary electrocardiogram: a free and underexploited diagnostic tool in angioplasty","volume":"7","author":"Meier","year":"2014","journal-title":"JACC Cardiovasc Interv"},{"key":"2020022804011919400_ytaa003-B5","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1056\/NEJMoa1415098","article-title":"Randomized trial of primary PCI with or without routine manual thrombectomy","volume":"372","author":"Jolly","year":"2015","journal-title":"N Engl J Med"},{"key":"2020022804011919400_ytaa003-B6","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.amjcard.2003.11.050","article-title":"Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial)","volume":"93","author":"Topaz","year":"2004","journal-title":"Am J Cardiol"},{"key":"2020022804011919400_ytaa003-B7","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jjcc.2016.05.018","article-title":"Indications and outcomes of excimer laser coronary atherectomy: efficacy and safety for thrombotic lesions\u2014the ULTRAMAN registry","volume":"69","author":"Nishino","year":"2017","journal-title":"J Cardiol"},{"key":"2020022804011919400_ytaa003-B8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.carrev.2018.10.022","article-title":"Simple percutaneous coronary interventions using the modification of complex coronary lesion with excimer laser","volume":"20","author":"Nakabayashi","year":"2019","journal-title":"Cardiovasc Revasc Med"},{"key":"2020022804011919400_ytaa003-B9","doi-asserted-by":"crossref","first-page":"e005860","DOI":"10.1161\/CIRCINTERVENTIONS.117.005860","article-title":"EROSION study (effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion): a 1-year follow-up report","volume":"10","author":"Xing","year":"2017","journal-title":"Circ Cardiovasc Interv"}],"container-title":["European Heart Journal - 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