Left Main bifurcation treatment with kissing stenting technique

- Operator : Duk-Woo Park

Left Main bifurcation treatment with kissing stenting technique
- Operator: Duk Woo Park, MD
Cilinical history

A 36-year old woman was admitted to our hospital due to progressive exertional angina for several months. 20 years ago, she received surgical repair for ventricular septal defect (VSD) at another hospital. Her coronary risk factors were hypertension and dyslipidemia. Her physical examiniation was normal and cardic enzymes were normal. His ECG and chest X-ray were unremarkable. Treadmill test showed positive result at stage 2. Echocardiography revealed no remnant shunt flow in the previous repaired site and no gross regional wall motion abnormality with LVEF ~65%.

Coronary angiographic findings

1) Rt. coronary angiography showed no significant stenosis.
2) Lt. coronary angiography showed short main and very tight stenosis at left main (LM) bifurcation site involving ostial left anterior descending artery (LAD) and ostial left circumflex (LCX) ( Movie 1, Movie 2)

Procedure

We planned kissing stenting technique for both LAD and LCX lesion. An 8 Fr JL3.5 guiding catheter was engaged in left coronary artery through a right femoral approach. An 0.014¡± BMW guidewire was positioned in the LAD. And then, LCX was tried with a 0.014¡± Soft wire. Xience V 2.75/15mm was inserted to LCX enough to cover form LM to LCX, and Xience V 3.5X18mm was placed from LM to LAD. Both stents were simultaneously deployed (Figure 1). Then final kissing balloon inflation using previous stent balloons was done. The final angiogram showed a good result (Figure 2, Figure 3).

Comments

  • Guanghui Chen 2010-09-08 the result is actually fine, I only concern about the long-term outcome. My experience tells the stenting at this site end of LM involving ostial left LAD and LCS is often accompanied with high restenosis rate.
  • Vijay Shah 2010-09-11 i agree with guanghui,,,,even with DES use ,kissing stent technique leads to high restenosis rate ...WE WOULD LIKE TO KNOW DR PARK OPINION ON THE LEAST RESTENOSIS RATE IN DISTAL LM BIFURCATION 2 STENT TECHNIQUE....DR V T SHAH ,MUMBAI INDIA.

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