Diffuse Long LAD Disease Treated with Two Drug-Eluting Stents Implantation
- Operator: Maurice Buchbinder, MD
Clinical presentation
A62-year-old woman was admitted due to effort chest pain for 4 months. His risk factor was diabetes. The electrocardiogram was normal and his left ventricular function was normal.
Baseline coronary angiogram
1. Left coronary angiogram showed diffuse narrowing of proximal to mid LAD and distal LCX (Figure
1, Figure 2).
2. Right coronary angiogram was normal.
Procedure
An 8F sheath was inserted through right femoral artery and the left coronary ostium was engaged with an 8F EBU catheter with 3.5 cm curve. A 0.014 inch BMW guidewire was inserted into the left anterior descending artery (LAD). Predilation of LAD was achieved with a 2.0 X 15 mm Maverick balloon 12 atm (2.2 mm) (Figure 3, Figure 4). IVUS examination showed significant plaque burden with heavy calcification at proximal to mid LAD. Therefore, a 3.0 X 10 mm cutting balloon was positioned at proximal LAD and deployed at 8 atm (3.0 mm) (Figure 5). After then, a 2.75 X 33 mm Cypher select stent was positioned at the mid to distal LAD and deployed by 16 atm (2.96 mm) and a 3.0 X 23 mm Cypher select stent was placed at the proximal LAD and deployed by 14 atm (3.15 mm) (Figure 6, Figure 7, Figure 8). Additional balloon was performed with a 3.5 X 12 mm Quantum balloon by 8 atm (3.33 mm) at mid to distal LAD and 14 atm (3.51 mm) at proximal LAD (Figure 9). Post-stent IVUS revealed malapposition of the proximal to mid LAD stent and additional ballooning at proximal segment of LAD stent was performed with a 3.5 X 11 mm Quantum balloon by 18 atm (3.62 mm). Final angiogram showed a well-expanded stents without residual narrowing (Figure 10, Figure 11).
