Work

Managing Dialysis-Associated Haemodynamic Instability in Critical Calcific Left Main Stem Disease With Tachycardia-Bradycardia Syndrome Using Intravascular Lithotripsy-Assisted Percutaneous Coronary Intervention and Permanent Pacemaker Implantation

Year: 2025

Type: article

Abstract: Patients with end-stage renal disease experience an accelerated form of systemic vascular calcification involving both intimal atherosclerosis and medial calcific sclerosis (Mönckeberg's sclerosis). This dual pathology creates unique challenges for coronary revascularisation. We present a dialysis-dependent woman with severe calcific critical left main stem bifurcation disease who underwent successful intravascular lithotripsy-assisted, optical coherence tomography-guided percutaneous coronary angioplasty. She had concomitant severe bradycardia from sinoatrial node dysfunction with paroxysmal atrial fibrillation, which resolved with implantation of a pacemaker. This case highlights the pathobiology underpinning dysmorphic vascular calcification in end-stage renal disease, its impact upon the complex cardiac presentation, and the need for a specialised device-based strategy to achieve a favourable outcome.

Source: Cureus

DOI: 10.7759/cureus.96545

Authors: Claire Ng, Adrian Ng Ping Vey, Keng Tian Ng, Kin Sing Fan

Institutions: Aberdeen Royal Infirmary, University of Manchester

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416133992