Slides
Primary Stenting for Totally Occluded Left Main Coronary Artery with Acute Myocardial Infarction
- Operator : Myeong-Ki Hong
Primary Stenting for Totally Occluded Left Main Coronary Artery with Acute Myocardial Infarction |
- Operator: Seung-Whan Lee, MD / Myeong-Ki Hong, MD, PhD |
Case Presentation |
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 -- ( ![]() 2. RCA was normal without intercoronary collaterals. |
Procedure |
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 (![]() |
Leave a comment
Sign in to leave a comment.
Comments