Slides
LM Trifurcation Disease with Mini-Crushing Technique and Kissing Balloon
- Operator : Seung-Jung Park
LM Trifurcation Disease with Mini-Crushing Technique and Kissing Balloon |
- Operators: Seung Jung Park. Young Hak Kim |
Clinical presentation |
A 62-year old man was suffered from effort chest pain for 3 months. So, He visited our hospital and got coronary angiography. That coronary angiogram showed tight stenosis of proximal RCA & left main trifurcation disease. So, He had a PCI at pRCA 1 month ago. His coronary risk factors were diabetes, hypertension and smoking. Baseline ECG showed normal sinus rhythm. Echocardiography revealed hypokinesia of basal inferior wall and normal LV systolic function. |
Baseline coronary angiogram |
1. Left coronary angiogram showed 70% narrowing
of distal LM, diffuse 60-70% narrowing of pLAD, 90-95% narrowing of LCX
os and diffuse 90% narrowing of ramus intermedius(RI).(Figure
1) |
Procedure |
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr EBU guiding catheter with 3.5cm curve. A 0.014 inch BMW wires was inserted into the LAD, LCX and RI. Cypher 3.0 X 33mm stent was deployed at RI diffuse lesion without predilatation. (Figure 2) And Another Cypher 3.5 X 33mmm stent was deployed at LM to pLAD with mini-crushing technique without predilatation. (Figure 3) Another 0.014 inch Rinato wire was reinserted into the RI. We planned additional 'kissing balloon post-dilation' at LM-pLAD, RI and LCX. We performed kissing balloon with 3.5 X 12mm Quantum at LM-pLAD, 3.0 X 12mm Quantum at RI and 2.5 X 20 mm at LCX respectively (Figure 4, Figure 5). IVUS study was done about LAD and RI. IVUS findings revealed underexpanded LAD & RI stent. So we planned additional ¡® kissing balloon post-dilation¡¯ at LM-pLAD and RI. We performed kissing balloon with 3.5 X 12mm Quantum at LM-pLAD and 3.0 X 12 Quantum mm at RI respectively (Figure 6). And then, IVUS study was performed. IVUS findings showed good stent position at LM-pLAD and RI (Figure 7, Figure 8). Final left angiogram showed that the procedure was successful (Figure 9). |
Comments