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Left Main os to Shaft Lesion Treated Using Single Sirolimus-Eluting Stent
- Operator: Seung-Jung Park, MD, Roxana Mehran, MD
Clinical presentation
A 72-year-old man was admitted due to effort chest pain for 3 months. His risk factor was smoking. The electrocardiogram was normal and his left ventricular function was normal.
Baseline coronary angiogram
1. Left coronary angiogram showed tight stenosis from ostium to shaft of LMCA and diffuse narrowing of 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 JL catheter with 4 cm curve. Two 0.014 inch Asahi Neo's soft wires were inserted into the left circumflex artery (LCX) and left anterior descending artery (LAD), respectively. IVUS examination showed significant plaque burden at mid LAD and severe atheromatous plaque burden from ostium to shaft of LMCA. Predilation of LMCA was achieved with a Black Hawk balloon 3.0 X 20 mm by 10 atm (3.18 mm) (Figure 3, Figure 4). Mid LAD lesion was predilated with a Ryujin balloon 2.5 X 20 mm by 6 atm (2.5 mm) (Figure 5, Figure 6). Therefore, a 3.0 X 33 mm Cypher select stent was positioned at the mid LAD and deployed by 16 atm (3.21 mm) (Figure 7, Figure 8). Additional ballooning was performed with stent balloon upto 20 atm (3.31 mm). And then, a 3.5 X 18 mm Cypher select stent was positioned at the LM os to shaft and deployed by 20 atm (3.83 mm) (Figure 9, Figure 10). Additional balloon was performed with a 4.0 X 8 mm Quantum balloon by 20 atm (4.19 mm) (Figure 11). Post-stent IVUS revealed malapposition of the proximal edge of mid LAD stent and additional ballooning at proximal segment of LAD stent was performed with a 3.5 X 15 mm Sprinter balloon by 16 atm (3.91 mm) (Figure 12). Final angiogram showed a well-expanded stents without residual narrowing (Figure 13, Figure 14).
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