Slides
Left Main Shaft & proximal LAD disease Treated by Simple Cross-Over Stenting
- Operator : Seung-Jung Park
Left Main Shaft & proximal LAD disease Treated by Simple Cross-Over Stenting |
- Operator: Seung-Jung Park, MD |
A 75 year-old gentleman was admitted with effort chest pain for several years. His coronary risk factor was hypertension. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=70%) 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 LM shaft and proximal LAD. Additionally, tight stenosis was observed at OM and intermediate stenosis was observed at mLAD ( Movie 1, Movie 2, Movie 3) 2. A right coronary angiogram was normal |
Procedure |
An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8 Fr JL 4.0 catheter with side hole. First above all, we intended to treat the OM stenosis. BMW 0.014-inch guidewire was inserted at OM and predilatation was performed with a 2.5 x 15mm Maverick balloon. Subsequently, Endeavor Integrity stent 3.0 x 18mm was implanted and post-stenting adjunctive balloon dilatation was done by using a 3.5 x 15mm Dura Star balloon (Figure 1, Movie 4). Thereafter, another BMW 0.014-inch guidewire was inserted at LAD. Predilatation was performed with a 2.5 x 15mm Maverick balloon at LM to pLAD (Figure 2). After predilatation, Promus Element stent 4.0 x 28mm was implanted at LM to pLAD (Figure 3). Thereafter, post-stenting adjunctive balloon dilatation using a 4.5 x 15mm Quantum balloon was performed at LM to pLAD. The following angiogram showed well-expanded stent. Finally, we checked mLAD FFR, which was 0.86. Therefore, we deferred PCI for the intermediate stenosis of mLAD. Final angiogram showed that the procedure was successful ( Movie 5, Movie 6). |
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