-Operator: Wang
Weimin, MD, China
A 65 year old gentleman presented with CAD, unstable
angina, and ECHO LVEF-70%.
History: Hypertension II - 6 years, Smoking -
40 years, Type 2 diabetes mellitus - 5 years
 Angiogram
| Left Main |
: Normal |
| LAD |
: A type 2 bifurcation lesion
involve first diagonal. Prox-Mid LAD shows
a tight 90% and long lesion. (Fig.1,
Fig.2,
Fig.3) |
| Lcx |
: Normal |
| RCA |
: Normal |
Procedural
Steps
Approach Right femoral Artery 7F
PTCA and stent to LAD/Diagonal:
7F JL 4 guiding catheter hooked LCA. A 0.014 PILOT
50 guide wire and BMW 0.014” crossed LAD
lesion and Diagonal respectively. The main branch
Prox-Mid lesion was pre-dilated with 2.5x20mm
Voyager at 12ATM (Fig.
4). 2 sequent Cypher Select stents
2.5x18mm and 2.5x33mm were implanted in the Diagonal
and LAD with "Crushing technique" (Fig.
5, Fig.
6).
Final kissing to optimize the result:
Routinely, the final kissing was requested to
optimize the result after crush stenting. The
BMW guide wire was drawn from the diagonal and
the PILOT 50 crossed the crushed stent struts
and exchanged to the diagonal branch. Re-wired
the BMW to the main branch. A new 2.5x20mm Voyager
crossed the crushed stent struts easily and successfully.
The previous Voyager re-crossed the main branch
Cypher Select stent (Fig.
7). Both 2 Voyager dilated simultaneously
at 16 ATM giving a successful result (Fig.
8, Fig.
9, Fig.
10). |
