Slides
Tight Left Main Bifurcation Lesion Treated with Simple Cross-Over Technique
- Operator : David E. Kandzari
Tight Left Main Bifurcation Lesion Treated with Simple Cross-Over Technique |
- Operator: David E. Kandzari, MD |
Case Presentation |
A 73 year-old man was admitted with effort chest pain for 2 months. His coronary risk factors were hypertension, hyperlipidemia and ex-smoking. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=72%) without regional wall motion abnormality. Thallium test showed reversible large perfusion defect of LAD territory. |
Baseline Coronary Angiography |
The left coronary angiogram showed diffuse and tight stenosis in distal LM to proximal LAD with relatively healthy LCX ostium ( Movie 1, Movie 2). The lesions at right coronary artery were not significant. IVUS examination revealed relatively normal LCX ostium. ( Movie 3;LAD IVUS, Movie 4;LCX IVUS). So, we intended to treat the lesion with simple cross-over technique. |
Procedure |
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL 4.0 catheter with side hole. A 0.014 inch BMW wire was inserted into the LAD and a 0.014 inch Fielder FC wire was inserted into the LCX. Predilatation was performed with a 2.5 x 20mm Maverick balloon at proximal LAD and distal LM (Figure 1, Figure 2). A 3.0 x 22mm Endeavor Integrity stent were implanted at proximal LAD (Figure 3). And then, a 3.5 x 18mm Endeavor Integrity stent was overlapped at proximal LAD to distal LAD crossing the LCX ostium (Figure 4). Following angiogram and IVUS showed a well-expanded stents without residual narrowing. ( Movie 5, Movie 6, Movie 7;LAD IVUS, Movie 8;LCX IVUS). |
Leave a comment