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Successful Drug Eluting Stent Implantation in Left Main Coronary Artery Disease with Anomalous Origin

- Operator: Keyur H. Parkkh, MD

Clinical Presentation

A 78 years old female was admitted with effort and accelerating chest pain for 15 days. Her coronary risk factor was hypertension. Baseline electrocardiogram showed a sinus rhythm with incomplete LBBB and echocardiography showed normal left ventricular function without regional wall motion abnormalities.

Baseline Coronary Angiogram

1. Right coronary angiogram showed normal findings.
2. Left coronary angiogram revealed anomalous origin of left main coronary artery (LMCA) from right cusp near right coronary origin and there was tubular 90% narrowing in distal segment of elongated LMCA (Figure 1, Figure 2).

Procedure

An 8F sheath was inserted through the right femoral artery and left coronary artery was engaged with 7F JR 3.5 Launcher guiding catheter. Fusion PTCA 0.014 inch wire was inserted across the lesion and predilation was performed with a Sprinter balloon (2.5mm X 20mm up to 10atm) (Figure 3, Figure 4). After predilation, Endeavor stent (3.5mm X 18mm up to 18atm) was implanted (Figure 5). Final angiogram showed a good result without residual narrowing and dissection with TIMI III flow (Figure 6).
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