Treatment of Distal LMCA Bifurcation Stenosis Using Modified T-Stenting Technique without Final Kissing Balloon Angioplasty

- Operator : Augusto D. Pichard

Treatment of Distal LMCA Bifurcation Stenosis Using Modified T-Stenting Technique without Final Kissing Balloon Angioplasty
- Operator: August D. Pichard, MD
Case Presentation
The patient was a 69 year old man with effort chest pain and dyspnea on exertion. His coronary risk factors were hypertension and hyperlipidemia. The echocardiography showed normal left ventricular function (EF=57%) without regional wall motion abnormalities. Treadmill test was positive at stage 1 and thalium SPECT showed reversible large defect in LAD and LCX territory.
Baseline coronary angiography
The left coronary angiogram showed tight stenosis at distal LMCA bifurcation ( Movie 1, Movie 2). The right coronary angiogram showed minimal disease.
Procedure
An 8F sheath was inserted through right femoral artery and the left coronary ostium was engaged with an 8F EBU 3.5 guiding catheter. A 0.014 inch BMW wires and a soft wire were inserted into the LAD and LCX, respectively. Distal LM to proximal LCX and proximal LAD lesions were predilated with 3.5 x 10mm cutting balloon (Figure 1, Figure 2). After predilation, 3.5 x 12mm Xience V stent was implanted at LAD os to proximal LAD first (Figure 3) and then 3.5 x 28mm Xience V stent was implanted at LM to proximal LCX using ¡®modified T-stenting technique¡¯. Final kissing balloon angioplasty was not done because angiogram showed a excellent result with well-expanded stents ( Movie 3, Movie 4).

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