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Ostial LM Disease

- Operator : Patrick W. Serruys

Ostial LM Disease
- Operators: Patrick W. Serruys, Chieng Chen Wu
Clinical presentation
A 51-year old man was suffered from effort-related chest pain for 1 month. So, he visited our hospital and got coronary angiography. That coronary angiogram showed ostial left main coronary artery disease. He had no history of MI, CABG or PCI. His coronary risk factors were diabetes, hypertension, hyperlipidemia and smoking. Baseline ECG showed normal sinus rhythm. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function. Thallium SPECT showed normal perfusion.
Baseline coronary angiogram

1. Left coronary angiogram showed 70% narrowing of ostial LM (Figure 1)
2. Right coronary angiogram showed near normal finding.
Procedure
A 7Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 7Fr JL guiding catheter with 4.0cm curve. A 0.014 inch BMW wire was inserted into the LAD. IVUS study was done about ostial LM disease. IVUS findings revealed heavy plaque burden in the ostial LM (Figure 2). Initially, we planned direct stenting with 4.0 X 12mm Taxus liberte stent at ostial LM (Figure 3, Figure 4). And then we performed post-stent balloon dilatation with Quantum 5.0 X 8mm (Figure 5). IVUS study was performed. IVUS findings showed good position & well expansion of the ostial LM stent (Figure 6). Final left angiogram showed that the procedure was successful (Figure 7).
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Comments

  • Ali Youssef 2008-05-03 Nice case; would you do any different way if IVUS isn't available? Is a PES different from a similar size BMS in this case?
  • umamahesh C Rangasetty 2008-05-18 Why drug eluting stent? why not bare metallic stent?
  • Young-Hak Kim 2008-09-22 In our results of MAIN-COMPARE registry published in New Engl J Med, DES was also beneficial even in ostial or shaft LM disease. As published in Circulation, the reported incidence of adverse event for long-term period was very low in non-bifurcation lesions. IVUS exam is crucial for LM intervention. We can hardly assess the true vascular size of LM without IVUS.
  • Maged Rizk 2008-11-10 Ostial Pro should be helpful for better positioning of stents in those ostial lesions
  • Young-Hak Kim 2008-11-17 Of course, dedicated ostial or bifurcated stenting is one of our future renovations.

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