Slides
Proximal edge ISR of LAD Stent Involving LMCA Bifurcation Treated with Simple Cross-Over Technique
- Operator : Seung-Jung Park
Proximal edge ISR of LAD Stent Involving LMCA Bifurcation Treated with Simple Cross-Over Technique |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 63 year-old man was admitted with recurrent chest pains. One-year ago, he had got PCI on proximal to distal RCA (Xience 3.5 x 23mm, 3.5 x 28mm, 3.0 x 28mm), proximal LAD (Promus 3.0 x 20mm), and diagonal (Promus 2.5 x 28mm). His coronary risk factors were hypertension, diabetes and dyslipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=59%) with newly developed apical hypokineaia. Treadmill test is positive and thallium test showed reversible perfusion defect in multiple areas. |
Baseline Coronary Angiography |
The left coronary angiogram showed tight ISR of LAD ostium, 50% narrowing of LM, intermediate lesion of mid to distal LAD, and diffuse subtotal narrowing of distal LCX. ( Movie 1, Movie 2) The right coronary angiogram showed intermediate disease. |
Procedure |
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 4.0 cm curve. A 0.014-inch Soft wire was inserted into the LCX. We failed several times for guidewire to pass into the LAD. Finally, by using the Crusade microcatheter, a 0.014-inch Fielder FC guidewire was inserted into LAD. After that, wire was exchanged by a 0.014-inch BMW guidewire. Proximal LAD to LM was predilated with 2.5 x 15mm Maverick balloon and 3.5 x 20mm Ryujin balloon. (Figure 1, Figure 2) And then 4.0 x 20mm Promus element stent was implanted at proximal LAD to LM (Figure 3) with post-dilatation using a 4.0 x 15mm Voyager NC balloon. (Figure 4) Final angiogram showed a well-expanded stents without residual narrowing. ( Movie 3, Movie 4) |
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