Recently, BioFreedom stent implantation was successfully performed for an elderly patient with trigeminal neuralgia, aged>80 years, in Qinghai Provincial People's Hospital, which is the first case in Qinghai province.

The patient self-reported chief complaint of trigeminal neuralgia for several years, which was not effectively treated after multiple surgeries. Professor Meng Qiang from Department of Neurology in the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) who specialized in treating trigeminal neuralgia was sent to Qinghai Provincial People's Hospital. After hearing the news, the patient sought Professor Meng Qiang for effective treatment. After communication with the specialist outpatient, Professor Meng Qiang recommended microvascular decompression of the trigeminal nerve. Coronary CTA in preoperative evaluation showed evident coronary calcification, moderate stenosis of the left main artery and segments 6-7 of the anterior descending branch, moderate stenosis of the counterlateral branch, mild stenosis of segments 11 and 12 of the circumflex branch and severe stenosis of segment 2 of the right coronary artery. The risk of anesthesia and operation is extremely high. Hence, coronary stent implantation should be prioritized. Subsequently, Professor Meng Qiang contacted a consultation with Professor Lei Xinjun from Department of Cardiology of our hospital, a member of the team sent to Qinghai Provincial People's Hospital. After comprehensive evaluation, Professor Lei Xinjun decided to perform percutaneous coronary intervention prior to surgery. However, the patient should orally take double-antibody drugs for 12-15 months after percutaneous coronary intervention. In addition, surgery is not allowed during this period, which significantly delays the patient's condition. With the support from Chen Xiuying, Director of Department of Cardiology, and Peng Hai, Director of Department of Medical Equipment, Professor Lei Xinjun actively contacted JWMS for purchasing BioFreedom stent, the only drug-coated stent drafted in European guidelines and approved by National Medical Products Administration, which can be applied to achieve 1-month ultra-short DAPT treatment for PCI patients with high bleeding risk.

 After active preoperative preparations, Professor Lei Xinjun led Physician Jing Linde and Physician Cai Anqi to perform the surgery. Intraoperative CTA showed the left coronary dominance, evident coronary calcification, mild stenosis of the left main artery and anterior descending branch, plaques of segment 13 of the circumflex branch with a stenosis rate of approximately 75% and a stenosis rate of 90% of segment 2 of the right coronary artery. Surgical strategies were implemented as follows. The circumflex branch was initially intervened, and then the right coronary artery was intervened. It took approximately 70 min to implant BioFreedom stents in the target lesions of the circumflex branch and the right coronary artery, respectively. The surgery was successfully completed and the patient was safely transferred to the ward.

BioFreedom stent is the optimal option for patients with high bleeding risk and limited time for surgery. This is also the first case of BioFreedom stent implantation in patients with coronary heart disease in Qinghai province, which plays an exemplary role.