Left Main Trifurcation Lesion Treated by Simple Cross-Over Stenting

- Operator : David E. Kandzari

Left Main Trifurcation Lesion Treated by Simple Cross-Over Stenting

- Operators: David E. Kandzari, MD, Vincent On-hing Kwok, MD

Case Presentation

An 80 year-old female was admitted with effort chest pain for six months. About twelve years ago, she was diagnosed as stable angina and has received medical treatment. However, effort chest pain was aggravated six months ago. Her coronary risk factors were diabetes, hypertension, and hyperlipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=66%) without RWMA. Treadmill test and thallium SPECT were not done. Syntax score was 37.

Baseline coronary angiogram

The left coronary angiogram showed significant stenosis at distal LM trifurcation lesion ( Movie 1). The right coronary angiogram showed diffuse mild stenosis at proximal to distal RCA ( Movie 2).

Procedure

A 7 Fr XB 3.5 guiding catheter with side hole was engaged into left coronary artery through right femoral approach. Two 0.014 inch BMW wires were placed into the LAD and LCX, respectively. They performed predilatation at LM to pLAD with Quantum balloon 2.5x15mm and Dura Star balloon 3.0x15mm, sequentially (Figure 1). And then they deployed the Promus Element stent 3.0x16mm at pLAD (Figure 2) and Promus Element stent 3.5x24mm at LM to pLAD (Figure 3). Post-stenting adjunctive balloon dilatation was performed at LM to pLAD with a Dura Star balloon 3.5x15mm. Finally, they performed additional kissing balloon with a Dura Star balloon 3.5x15mm at LM to pLAD and a Maverick balloon 2.0x15mm at LM to pLCX (Figure 4). Final angiogram showed a good result ( Movie 3).