Slides
Chronic Occlusion of LAD Treated by Stenting With PercuSurge GuardWire
- Operator : Teguh Santoso
| Chronic Occlusion of LAD Treated by Stenting With PercuSurge GuardWire |
| - Operator : Teguh Santoso, MD |
| Case presentation |
| The patient was 50 year-old male. He presented with an effort chest pain for 6 weeks. He had a hyperlipidemia as a coronary risk factor. Echocardiography showed normal LV ejection fraction of 81% without regional wall motion abnormality. |
| Baseline coronary angiography |
| 1. Left coronary angiogram showed subtotal occlusion
with TIMI 3 flow at proximal LAD bifurcation site with bridging collaterals
from proximal LAD to first diagonal branch (D1) and from LCX to D1 (Figure
1, Figure
2).
2. RCA was normal. |
| Procedure |
| A 7F sheath was inserted through right femoral artery and the left coronary was engaged with a 7F XB catheter. A 0.014² intermediate wire was advanced into the distal part of D1. Then aspiration was done with Export catheter (Figure 3). Despite the absence of appreciable change in the proximal LAD stenosis, flow to the LAD was re-established. LAD appeared as a small vessel (Figure 4). Percusurge wire was introduced, but it was difficult to be maneuvered in the LAD. Percusurge balloon was positioned at the LAD-D1 branching point and aspiration was performed after balloon dilatation of the LAD (Figure 5). Following angiogram showed remained narrowing in the LAD lesion (Figure 6). Percusurge balloon was inflated just distal to the previously occluded LAD segment and a coronary stent was implanted (Figure 7). After stenting, aspiration was repeated, though no angographic thrombus was visible (no more macroscopic debris was retrieved) (Figure 8). After stenting, aspiration and repeated intracoronary nitrate was administration. LAD still appeared as a small vessel with some focal stenosis (Figure 9). Final result after intracoronary nitrate and further dilatation using a conventional balloon showed good patency of LAD and mild narrowing of D1 (Figure 10, Figure 11). |
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