Primary Stenting for Totally Occluded Left Main Coronary Artery with Acute Myocardial Infarction
|- Operator: Seung-Whan Lee, MD / Myeong-Ki Hong, MD, PhD|
|The patient was 50 year-old male. He presented to the emergency room with persistent chest pain for 3 hours. He had a 20 pack-year of smoking as a coronary risk factor. Baseline ECG showed ST elevation on precordial leads. Initial blood pressure was 60/30mmHg. He underwent emergent coronary angiography for primary PCI.|
|Baseline Coronary angiography|
|1. Coronary angiogram showed total occlusion in left main coronary artery
with TIMI 1 flow
-- (Figure 1).
2. RCA was normal without intercoronary collaterals.
|An 8F sheath was inserted through both femoral artery and IABP was initially inserted through left femoral artery. The left coronary was engaged with an 8F Judkins catheter through right femoral sheath. Coronary angiogram showed total occlusion in shaft of left main coronary artery (LMCA) with TIMI 1 flow. At first, occluded LMCA was crossed with a 3.0x20 mm balloon without inflation to delineate accurate lesion. Following angiography showed totally occluded LMCA with TIMI 2 flow (Figure 2). The lesion was stented with a 4.0x12 mm heparin coated Jo stent at 6 atm without predilatation (Figure 3). After stenting, angiography revealed indentation of mid portion of stent (Figure 4). Thus additonal high pressure dilatation was performed with the stent balloon at 12 atm (Figure 5). Final angiography showed well deployed stent in the LMCA shaft without residual stenosis or dissection and with the presence of TIMI 3 flow (Figure 6). The hospital course was uneventful after stenting.|