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).

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