LM Bifurcation Treatment Using Simple Cross-over Technique

- Operator : Seung-Jung Park

LM Bifurcation Treatment Using Simple Cross-over Technique
- Operator: Seung-Jung Park, MD, Young-Hak Kim, MD
This patient was a 50-year-old woman and had heart transplantation 9 years ago. A coronary angiogram done as a follow-up protocol for heart transplant patients revealed critical stenosis of distal LMCA and bifurcation.
ECG showed non-specific finding, and echocardiogram showed normal LV systolic function without regional wall motion abnormality. She did not complain of specific symptoms but thallium scan showed large reversible perfusion defect in LAD territory. Dr. Park selected 7Fr JL4 guiding catheter to engage LMCA and obtained coronary angiogram. At first sight, the stenotic lesion at the LM bifurcation site was so tight but the appearance of distal LMCA, LCx ostium and LAD ostium was anatomically ambiguous (Figure 1).
After Dr. Park crossed the 0.014 inch BMW wires into the LAD and LCx sequentially, then he performed intravascular ultrasound (IVUS) evaluation for LAD and LCx ostium. It showed the significant stenosis at the distal LMCA with cross sectional area of 3.5mm2, however, LCx ostium appeared quiet normal, and proximal LAD had mild atherosclerotic lesion extending to the first diagonal branch
(Figure 2, Figure 3). Dr. Park said "There is no disease at LCX ostium. So, I don't worry about jailing of the LCx ostium when I cross over it." Dr. Park deployed the Xience stent 4.0 x 23mm with 12atm up
to 15atm crossing LCx ostium without predilation and he applied post-balloon dilatation using Quantum 4.5 x 15mm balloon with 20 atm (Figure 4, Figure 5). Final angiogram showed the perfect results
without compromising LCx ostium Figure 1 (Figure 6).

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