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LM Bifurcation Lesion Intervention with Crossover
- Operator: Antonio Colombo, MD
Case Presentation
A 53-year-old male was admitted for abnormal coronary CT findings. He had effort chest pain. Physical examination, simple chest radiograph, electrocardiography were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed discrete lesion at distal LM, and tubular lesion at LAD ostium. LCX had a discrete stenosis at ostial portion at moderate degree ( Movie 1, Movie 2).
  2. The right coronary angiogram showed normal angiogram ( Movie 3).
Procedure
A 6 Fr sheath (Terumo) was inserted through the right femoral artery and left coronary artery was engaged with a 6 Fr XB 3.5 guiding catheter. Two 0.014-inch BMW 190 cm wires were inserted into LAD and LCX, respectively. Before intervention, IVUS was used to identify lesion characteristics of LAD and LCX, in which diffuse LM disease were identified with tight ostial stenosis of LAD and LCX ( Movie 4, Movie 5 respectively). Neon NC balloon sized 3.5 x 15 mm was used to dilate stenotic lesion of LM-proximal LAD ( Movie 6). After dilation, XIENCE Sierra sized 3.5 x 15 mm stent was deployed at the pre-dilated lesion ( Movie 7). Additional 0.014-inch BMW 190cm wire was inserted into LCX to gain access to jailed LCX. Emerge 3.0 x 15 mm-sized balloon was inflated up to 14 atm to dilate jailed proximal LCX ostial lesion ( Movie 8). Kissing balloon procedure was performed at LM-pLAD and pLCX ostial lesion using Neon NC 3.5 x 15 mm up to 8 atm (3.36) and Emerge 3.0 x 15 mm up to 8 atm (3.11), respectively ( Movie 9). POT was performed using other EMERGE NC 4.0 x 8 mm up to 22 atm (4.25) to optimize stent apposition ( Movie 10). Final angiogram and IVUS showed successful results ( Movie 11, Movie 12).
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