Slides
LM with mLAD CTO Lesion Treated by Antegrade Approach
- Operator : Seung-Jung Park
LM with mLAD CTO Lesion Treated by Antegrade Approach |
- Operator: Seung-Jung Park, MD |
Clinical presentation |
This patient was a 55-year-old man having a history of cerebral infarction 1 month ago. he already underwent angiography due to abnormal echocardiogram finding and diagnosed as LM with LAD CTO at outside hospital. Although bypass surgery was recommend as a primary treatment option, he was reluctant to surgery, therefore visited our hospital for secondary opinion. His coronary risk factor was hypertension. The ECG showed T-wave inversion in I, aVL, V5-6 leads and cardiac enzymes was unremarkable. The echocardiography showed severe LV dysfunction (EF=34%) with regional wall motion abnormality in LAD and LCX territories. thallium SPECT showed reversible perfusion defect in multiple areas. |
Baseline coronary angiogram |
1. The left coronary angiogram showed 60% narrowing of LM, diffuse 60% narrowing of pLAD and total occlusion from mLAD with TIMI 0 flow.( Movie 1, Movie 2) 2. The right coronary angiogram showed no significant luminal narrowing, grade 2 collateral flow was shown from RCA to LAD.( Movie 3) |
Procedure |
First above all, an IABP was inserted through Lt femoral artery. The left coronary ostium was engaged with an 8Fr JL4 SH guiding catheter through Rt femoral artery. A 5Fr JR4 diagnostic catheter was engaged in the right coronary artery through Rt radial approach. At first, by using a Finecross¢ç 0.014 inch 1.8 Fr -130cm Coronary Micro-Guide catheter, wiring using Fielder XT 0.014 inch -180cm wire was antegradely tried into mLAD CTO lesion and passed the lesion.(Figure 1) We changed Fielder XT to BMW 0.014 inch -300cm wire. After removal of microcatheter, several balloon dilations with Maverick 2.0 X 20 mm was performed at proxymal to mid LAD.(Figure 2) After IVUS examination, another BMW 0.014 inch -190cm wire was positioned into the diagonal branch.(Figure 3) And further dilation was done at proximal to mid LAD with Amadeus 2.5 X 15mm balloon. Finally, balloon dilations with Nimbus Salvo 4.0 X 13mm was performed at LM.(Figure 4) The consecutive three Promus Element stent (4.0 X 20mm+3.0 X 28mm+2.5 X 28mm) were deployed at mid LAD to LM.(Figure 5) Post-adjuvant balloon dilation was done and the final angiogram showed successful results.( Movie 4) |
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