Slides

LM Bifurcation Disease with LAD and LCX Bifurcation Lesions Treated with V-Stent Technique Using Sirolimus-Eluting Stents

- Operator : Seung-Jung Park

LM Bifurcation Disease with LAD and LCX Bifurcation Lesions Treated with V-Stent Technique Using Sirolimus-Eluting Stents
- Operators: Seung-Jung Park, Myeong-Ki Hong
Clinical presentation
A 75-year old man was admitted with new onset resting chest pain for 3days. His coronary risk factors were diabetes, hypertension and hyperlipidemia. Baseline ECG showed complete RBBB. Echocardiography revealed akinesia of basal septum and basal inferior wall with normal LV systolic function.
Baseline coronary angiogram

1. Left coronary angiogram showed significant narrowing at distal LM bifurcation (Figure 1) with diffuse 70-80% stenosis proximal LAD, subtotal occlusion proximal LCX and diffuse 80-90% stenosis distal LCX (Figure 2, Figure 3).
2. Right coronary angiogram showed previous stent at mid RCA (Figure 4).
Procedure
A 8Fr sheath was inserted into the right femoral artery. The left coronary ostium was engaged with a 8Fr XB guiding catheter with 3.50㎝ curve. Two 0.014 inch BMW wires were inserted into the LAD and the LCX (Figure 5). IVUS study was done about LM bifurcation, LAD, LCX ostium and distal LCX. IVUS findings revealed heavy plaque burden in the LM bifurcation, proximal LAD, LCX ostium and distal LCX lesions (Figure 6). Initially, we planned ‘V-stent technique’ for proximal LAD and LCX ostium lesions. A 2.5 X 20 mm Pleon balloon was inflated at distal LCX. After pre-dilation, 2.75 X 33 mm Cypher stent was positioned at the distal LCX, then 2.75 X 33 mm stent balloon was inflated at distal LCX (by 16 atm, 2.96 mm) (Figure 7). Additional balloon dilatation was performed at distal LCX with 2.5 X 20 mm Pleon (by 18 atm, 2.78 mm). For LCX ostium lesion, pre-dilations were done with 3.0 X 20 mm SafeCut NM (by 8 atm, 3.0 mm). And for LAD ostium lesion, pre-dilations were done with 3.0 X 20 mm SafeCut NM (by 8 atm, 3.0 mm). We used V-stent technique; 3.5 X 28 mm Cypher stent was positioned in distal LM to proximal LAD by 10 atm (3.5 mm) and 3.5 X 33 mm Cypher stent was positioned in distal LM to proximal LCX by 18 atm (3.77 mm) (Figure 8, Figure 9). Additional 'kissing balloon post-dilation' was perfomed at proximal LAD and proximal LCX with 3.5 X 28 mm stent balloon (by 10 atm, 3.5 mm) and 3.5 X 33 mm stent balloon (by 10 atm, 3.5 mm), respectively (Figure 10). IVUS study was done about LCX (Figure 11). For LCX ostium and LAD ostium, high pressure balloon dilation was performed with 3.5 X 8 mm Fortis by 20 atm (3.65 mm) and 3.5 X 15 mm Runner by 20 atm (3.74 mm). A final kissing balloon dilation was performed with a 3.5 X 15 mm Runner (16 atm, 3.70mm) in the LAD and another 3.5 X 8 mm Fortis (16 atm, 3.58 mm) in LCX (Figure 12). Final left angiogram showed that the procedure was successful (Figure 13, Figure 14).
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