 Case
presentation
A
66 year-old female presented with chest
pain upon effort for 3 years. She had a
diabetes mellitus as a coronary risk factor.
The echocardiography showed a LV ejection
fraction of 54% with hypokinetic wall motion
abnormalities in the LCX territory. Left
coronary angiogram showed a diffuse LCX
stenosis with a subtotal occlusion and a
middle LAD stenosis (Figure
1). Right coronary angiogram
showed a mild narrowing at the distal RCA.
After insertion of a conventional wire to
the LCX (Figure
2), a 2.0X20mm AQUA T3 balloon
was advanced into the lesion (Figure
3). Although the LCX lesion was
very tight and back-up support of the Judkins
guiding catheter was not sufficiently good,
advancement and balloon dilatation of the
AQUA balloon was easily performed (Figure
4). The following angiogram after
a balloon dilatation showed a very long
lesion of the distal LCX (Figure
5). Therefore, additional balloon
dilatations with a 2.0X30mm AQUA T3 balloon
were performed for long duration (Figure
6, Figure
7). Then, a 2.75X33mm Cypher
stent was implanted to treat the tightest
lesion with a dissection and an intramural
hematoma (Figure
8). Final angiogram showed a
successful result (Figure
9). The LAD lesion was also treated
with direct stenting with a 2.5X13mm Cypher
stent.
Operator’s
impression
Because
the LCX lesion was so tight and back-up
support of the guiding catheter was not
good, selection of a suitable balloon to
cross the lesion was not easy. However,
the AQUA T3 balloon could be easily advanced
without any resistance. From the experience
of this case, I am convinced that the AQUA
T3 balloon with a low profile and a good
trackability will be a very useful balloon
for complex lesion interventions.
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