Slides
LM Bifurcation Disease
- Operator : Ron Waksman
| LM Bifurcation Disease |
| - Operators: Ron Waksman, Joo-Young, Yang |
| Clinical presentation |
A 76-year old man was admitted with effort-related chest pain for 5 months. He received previous PCI at 2008.1.30. about pLCX lesion with Cypher 3.0 X 18mm. His coronary risk factor is diabetes, hyperetension. Baseline ECG was normal. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function. Tredmill test showed positive ischemia at stage 2. |
| Baseline coronary angiogram |
1. Left coronary angiogram showed 60% narrowing
of distal LM, 50-60% narrowing of mid LAD. (Figure
1, Figure
2) Previous stenting site at proximal LCX was patent. |
| Procedure |
| A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB guiding catheter with 3.5cm curve. A 0.014 inch BMW wire was inserted into the LAD. IVUS study was done about LAD to LM. IVUS study revealed heavy plaque burden with negative remodeling at mid-LAD (Figure 7) but well maintained CSA of LM & proximal LAD. So, predilatation with Ryujin balloon 2.5X15mm (by 10atm, 2.63mm) was done. (Figure 3, Figure 4) And then Taxus liberte stent 2.75X38mm (by 12 atm, 2.98mm) was deployed at mLAD across diagonal branch without protection. (Figure 5, Figure 6) FFR was checked by intracoronary adenosine 84microgram bolus injection. Values was not accurate but approximate value is 0.84/0.86 pre/post adenosine injection, respectively. One more IVUS study was done LM to LAD & stenting site of mid-LAD.(Figure 8, Figure 9, Figure 10) Operator finished all procedures. |
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