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LM Bifurcation Lesion Intervention
- Operator: Seung-Jung Park, MD
Case Presentation
A 74-year-old female was admitted for effort chest pain. She underwent percutaneous coronary intervention 1 year ago at our hospital. Synergy 2.5 x 38 mm and 3.0 x 38 mm had been inserted at p-mRCA. Additionally, Synergy 3.0 x 28 mm and 3.5 x 24 mm had been inserted at p-mLAD. Thallium SPECT showed reversible perfusion defect in anterolateral and inferolateral wall. 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 previous patent stent at LM-pmLAD, pLCx discrete 80% stenosis and OM diffuse 70% stenosis ( Movie 1, Movie 2). FFR in pLCx decreased from 0.86 to 0.70 after adenosine infusion.
  2. The right coronary angiogram showed patent previous stent at pmRCA and dRCA diffuse 20% stenosis ( Movie 3).
Procedure
A 8 Fr sheath (Terumo) was inserted through the right femoral artery and left coronary artery was engaged with a 8Fr JL 4.0 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 LCx disease was identified with tight ostial stenosis with diffuse OM stenosis and patent p-mLAD stent ( Movie 4, Movie 5). Emerge NC balloon sized 2.5 x 15 mm was used to dilate stenotic lesion of OM ( Movie 6). After dilation, XIENCE Sierra sized 2.5 x 15 mm stent was deployed at the pre-dilated lesion ( Movie 7). Post stent balloon was performed with Emerge NC balloon sized 2.5 x 15 mm up to 20 atm (diameter 2.61) to dilate OM stent. Raiden 3 3.5 x 15 was used to dilate stenotic lesion of LM-pLCx ( Movie 8). Xience sierra stent 3.5 x 23mm was deployed at the pre-dilated lesion ( Movie 9). Sapphire NC 2.5 x 15mm was inflated upto 25 atm (diameter 2.7) at pLAD ( Movie 10). Powered Lacrosse 3.5 x 15mm was performed up to 25 atm (diameter 3.7) at LM-pLCX ( Movie 11). Sapphire NC 4.0 x 15 mm was inflated up to 20 atm (diameter 4.27) at LM-pLAD ( Movie 12). Additional kissing balloon procedure was performed at LM-pLAD and pLCX ostial lesion using Sapphire NC 4.0 x 15 mm up to 10 atm ( diameter 3.93 ) and Powered Lacrosse 3.5 x 15 mm up to 10 atm (diameter 3.42) respectively ( Movie 13). Final angiogram and IVUS showed successful results ( Movie 14, Movie 15).
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