Case

LM Bifurcation-LCX Crossover (FFR Evaluation)

- Operator : Seung-Jung Park

LM Bifurcation-LCX Crossover (FFR Evaluation)
- Operator: Seung-Jung Park, MD
Clinical Information
- Relevant clinical history and physical exam:
A 68-year old woman was admitted with effort chest pain for 1 week. She underwent stenting with 3.5 * 30 mm GFX in mid LAD and 3.5 * 18mm GFX in OM1 at ten years ago. And at seven years ago, she received 3.5 * 18 mm RS in pLCX due to stable angina. She had a past medical history of diabetes and hypertension. Chronic medication contained ASA, Ca channel blocker, beta blocker and statins.

- Relevant test results prior to catheterization:

The ECG showed no significant ST changes. The ejection fraction was 55% with akinesia of LV apex and posterolateral wall.

- Relevant catheterization findings:
Baseline coronary angiogram showed a diffuse 70 % narrowing of LM, LAD ostium and tight stenosis of OM2 (Figure 1a, Figure 1b). The lesions at Rt.coronary arteries were not significant.

Interventional Management
- Procedural step:
7 Fr Judkins 3.5 guiding catheter was engaged in the left coronary artery through the femoral approach. Predilation of dLM to LAD with 3.0 * 10mm cutting balloon was done (Figure 2). And then, 3.5 * 28mm Cypher stent was deployed at pLAD to LM across LCX without protection (Figure 3). After stenting, additional balloon dilation was done with 4.0 * 12 mm Quantum balloon(non-compliant balloon). At that time, angiogram showed LCX ostium was jailed (Figure 4a, Figure 4b). So, We checked FFR by intracoronary adenosine bolus infection. The values was 0.95/0.89 pre/post adenosine injection, respectively (Figure 5). According to FFR results, kissing balloon was performed with 3.5 * 20 mm Pleon balloon at pLAD to LM and 3.0 * 20mm Ryujin balloon at pLCX to LM (Figure 6). After kissing balloon, FFR was 1.0/0.97 pre/post adenosine injection, respectively (Figure 7). Final angiogram showed a well-expanded LM to pLAD stent without jail of LCX ostium (Figure 8a, Figure 8b).

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