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Overlapped Stenting and Kissing Balloon of LM Birfurcation Lesion
- Operator: Duk-Woo Park, MD
Case Presentation
A 77-year-old female was admitted for dyspnea on exertion aggravated from 4 weeks ago. She had a history of hypertension and diabetes mellitus. She underwent percutaneous coronary intervention at pLCx and pmLAD for unstable angina 6 months ago. The physical examination and electrocardiogram were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed severe stenosis at distal LM, proximal LAD and instent restenosis of pLCX ( Movie 1, Movie 2, Movie 3).
  2. The right coronary angiogram showed mild stenosis at mid RCA ( Movie 4).
Procedure
An 7 Fr sheath was inserted through right femoral artery and left coronary artery was engaged with an 7 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into the LAD and 0.014-inch NEO`s(Sion) 180cm wire was inserted into the LCX. IVUS was done, showing de novo stenosis of dLM, ISR of stent at the pLAD (Figure 1) and underexpansion of previous stent at the pLCX (Figure 2). First balloon dilation was performed with an NC Emerge 4.0 x 15 mm balloon at distal LM to pLCx (Figure 3). And then we overlapped a Xience Sierra stent sized 4.0 x 23 mm into the LM ostium to pLAD ( Movie 5). And additional kissing ballooning was performed by using NC Emerge 4.0 x 15 mm at the LM to pLAD and NC TREK 4.0 x 15 mm at pLCX ( Movie 6). Final angiogram ( Movie 7, Movie 8) and IVUS of LM (Figure 4), pLAD (Figure 5) and pLCx (Figure 6) showed the successful result.
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