Slides
Left Main Bifurcation Disease Treated by Simple Cross-Over Stenting
- Operator : Seung-Jung Park
Left Main Bifurcation Disease Treated by Simple Cross-Over Stenting |
- Operator: Seung-Jung Park, MD |
A 61 year-old woman was admitted with effort chest pain for 6 months. About ten years ago, she underwent PCI at mLAD, dLCX, pRCA and dRCA. Her coronary risk factors were diabetes mellitus and hyperlipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality. Treadmill test and thallium test were not done. |
Baseline Coronary Angiogram |
1. A left coronary angiogram showed significant tight narrowing of distal LM bifurcation and patent stent at mLAD and dLCX ( Movie 1, Movie 2). 2. A right coronary angiogram showed patent stent at pRCA and dRCA ( Movie 3). |
Procedure |
An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8 Fr JL 3.5 catheter with side hole. First, Kinetix 0.014-inch guidewire was inserted at LCX and BMW 0.014-inch guidewire was inserted at LAD. We performed IVUS examination to determine the treatment strategy for the distal LM bifurcation disease. IVUS showed minimal stenosis at LCX ostium (IVUS LCX Movie 4). Therefore, we intended to treat the lesion with simple cross-over technique. Predilatation was performed with a 2.5 x 20mm Black Hawk balloon at LM to pLAD (Figure 1). After predilatation, Promus Element stent 4.0 x 24mm was implanted at LM to pLAD (Figure 2). Thereafter, adjunctive post-stenting balloon dilatation using a 4.0 x 15mm Quantum balloon was performed at LM to pLAD. The following angiogram showed well-expanded stent. We checked LCX FFR, which was 0.93. Therefore, we finished the procedure. Final angiogram showed that the procedure was successful ( Movie 5, Movie 6). |
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