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Simple Stenting for a Distal Right Coronary Quadrifurcation Lesion with Sirolimus-Eluting Stent
- Operator: Seong-Wook Park, MD
The patient was a 57 year old man with exertional chest pain for 1 year and resting chest pain for 1 month. His risk factors included hypertension and diabetes mellitus. His baseline ECG was normal. His resting LV ejection fraction was 60% with no regional wall motion abnormalities. Baseline coronary angiogram showed a distal right coronary artery (RCA) quadrifurcation lesion (Figure 1, Figure 2).
Procedure
We planned to insert Cypher stents from distal RCA to posterior descending artery (PDA) crossing ostia of other three branches with optional kissing balloon dilatation. An 8F JR4 guiding catheter was engaged at the ostium of the RCA. A 0.014 inch Floppy guide wire and a Choice PT wire were placed into the posterolateral (PL) branch and the PDA, respectively (Figure 3). After predilation with a Stormer balloon (2.5 x 20 mm), two Cypher stents (3.5 x 23 mm at 14 atm to 3.64 mm and 2.75 x 28 mm at 14 atm to 2.86mm) were deployed consecutively at PDA and distal RCA (Figure 4, Figure 5). Then, a choice PT wire was re-introduced into the PL branch through the stent strut for kissing balloon inflation. A Stormer balloon (2.5 x 20 mm) and a maverick balloon (2.5 x 20 mm) was placed at the PDA and PL branch. Then, final kissing balloon inflation was performed (Figure 6 , Figure 7 , Figure 8 ). Although there was a significant compromise of the other branch, no more procedure was done because the branch vessel looked not so big to be treated. The final angiogram revealed optimal stent expansions without significant residual narrowing in both treated branches (Figure 9, Figure 10).
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