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Long Cypher Implantation for Very Long Coronary Lesion
- Operator: Myeong-Ki Hong, MD
History
A 75 year-old man was admitted with resting chest pain for 1 month. His coronary risk factors were hypertension and smoking. Echocardiography showed normal LV function without regional wall motion abnormality. A coronary angiogram showed a significant diffuse narrowing from the ostial to middle LAD and a tubular narrowing at the obtuse marginal branch (Image 1, Image 2). Right coronary angiogram was near normal.
Procedure
A 7F sheath was inserted through the right femoral artery, and the left coronary ostium was engaged with a 7F, JL 3.5 catheter. The LAD was wired with a 0.014 inch Floppy wire. A 20 mm Black-Hawk balloon was used to predilate the lesion at the distal LAD (upto 2.73 mm/13 atm) and middle LAD (upto 2.73 mm/14 atm). Then, a 3.0 mm x 23 mm Cypher stent was positioned at the middle LAD and deployed at 20 atm(3.3 mm) (Image 3). Two other Cypher stents (3.0 mm x 23 mm and 2.5 mm x 33mm) were deployed at the proximal and distal LAD (Image 4, Image 5). For complete lesion coverage at the ostial LAD, the last Cypher stent (3.5 mm x 18mm) was implanted (Image 6). Final angiogram showed a good result (Image 7, Image 8, Image 9).
Follow up angiogram
Fortunately, all the stented segments were patent at 6-month follow-up angiogram (Image 10, Image 11).
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