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Left Main Coronary Artery Ostial Stenosis, Treated with Stenting Alone

- Operator : Seung-Jung Park, MD

Case Presentation
The patient was 44 year-old male admitted with exertional chest pain for 4 months. His baseline ECG showed normal. Echocardiography showed good left ventricular function with an ejection fraction of 65%.
Baseline Coronary Angiography
Left coronary angiogram showed ostial LMCA stenosis with relatively short LMCA (Figure 1, Figure 2). Distal reference vessel diameter was measured 4.3 mm by QCA analysis. LAD, LCX, and RCA were normal.
Intravascular ultrasound
IVUS image showed the tight stenosis at LMCA ostium without large plaque burden suitable for debulking (Figure 3). The lesion EEM (external elastic membrane) diameter and area were measured 4.12 mm and 12.2 mm2, respectively. Distal reference EEM area was 15.2 mm2 (Figure 4).
A 10 F sheath was inserted through right femoral artery and the left coronary was engaged with a 10 F EBU catheter. Left main to LAD was wired with 0.014 F Flexi wire for DCA. However, we decided to treat this lesion with stenting alone after IVUS examination because the plaque burden in LMCA ostium was not much to perform DCA and the lesion was shrunk with negative remodeling. Without predilation, a 4.0 mm x 8 mm Penta stent was deployed to 4.18mm at 12 atm in the lesion confined to ostial LMCA. Following angiogram showed very good result with minimal protrusion of stent into the aorta (Figure 5, Figure 6). IVUS image also showed good result with a final stent CSA of 13.5 mm2 (Figure 7).
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