Slides

Stenting at Ostial Left Anterior Descending Artery Covering Distal Left Main for Complete Lesion Coverage

- Operator : Cheol Whan Lee

Stenting at Ostial Left Anterior Descending Artery Covering Distal Left Main for Complete Lesion Coverage
- Operator: Cheol Whan Lee, MD
Clinical history

A 74 year-old male admitted with stable angina for 6 months. He had hypertension and ex-smoking for coronary risk factors. His baseline ECG was normal. Echocardiography showed good left ventricular function with an ejection fraction of 59%. Thallium SPECT showed reversible perfusion defect in the Left anterior descending (LAD) artery territory.
Baseline coronary angiography

Left coronary angiogram showed a stenosis at ostial LAD (Figure 1, Figure 2). IVUS examination revealed involvement of the distal left main (LM) coronary artery with normal left circumflex artery (LCX) ostium (Figure 3, Figure 4). We intended to treat the lesion with a Cypher stent covering distal LM for complete lesion coverage.
Procedures

A 7F sheath was inserted through the right femoral artery, and the left coronary ostium was engaged with a 7F JL catheter with 4.0cm curve. A 0.014 inch Neos wire was inserted into the LAD. Then, predilation was performed with a 3.0 x 15 mm Maverick balloon at ostial LAD (Figure 5). A 3.5 x 18mm Cypher stent was positioned at the ostial LAD covering the distal LM and deployed by 12 atm (3.5mm) (Figure 6). After stenting, additional balloon dilatation was done with a 4.0?10mm Stomer balloon at 14 atm (4.36mm) (Figure 7). Final angiogram showed a well-expanded stent without residual narrowing or stent jail. (Figure 8, Figure 9).

Follow up coronary angiography

Six-month follow-up angiogram showed a patent stent (Figure 10, Figure 11).

Comments

  • Gamal Abu-Omar 2005-02-27 Nice case. What would you do if plaque shift to LCX compromise its ostium? Gamal Abu-Omar, MD
  • Young-Hak Kim 2005-03-04 If significant stent jail occur at the ostial LCX, kissing balloon inflation would be a provisional option. In our experience, additional stenting at the LCX ostim was not required in any cases intended to be treated with this approach.
  • r.p.singh 2005-03-11 though lcx is not jailed but stent struts are across the ostium of lcx. is not it necessary to do low pressure kissing baloon
  • r.p.singh 2005-03-11
  • Debabrata Dash 2005-04-02 It is a good demonstration,but why you did not do IVUS when you involved LMCA threby causing stent protrusion in LCX.
  • Young-Hak Kim 2005-04-05 We have tried to use IVUS examination in all ostial LAD interventions. The device has a crucial role in assesing lesion characteristics. Final kissing balloon dilatation does not seem to be necessary in cases without angiographic compromise at the ostial LCX, even in protrusion of the stent.
  • DEWI 2005-05-09 If there was no disease in the distal left main stem,would you then do a precise positioning of the stent in the ostium of the LAD.Do you then use a kissing wire/balloon to protect the ostium of CX if plaque shift occurs?
  • DEWI 2005-05-09 How long do you use dual antiplatelet therapy for these patients?
  • Zhonghan Ni 2007-11-05 IVUS examination in all ostial LAD interventions makes sense,otherwize this leision might be stent sparing the distal LM.
  • ANAZI 2008-09-13 I agree with operators further kissing at te LCX ostium may do more damage than good

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