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Treatment of Distal LMCA Trifurcation Lesion Using Kissing Stent Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 75 year-old woman was readmitted for staged PCI at LM trifurcation lesion. Two weeks ago, she visited our hospital due to effort chest pain for about 6 months. At that time, echocardiography showed normal LV systolic function (EF 60%) without RWMA, treadmill test was positive at stage 2, and coronary angiogram showed left main with triple vessel diseases. Therefore, she firstly underwent PCI with two Promus Element stents (3.0 x 38mm and 2.75 x 38mm) at proximal to mid RCA lesion. Her coronary risk factors were hypertension and hyperlipidemia. SYNTAX score was 35.
Baseline coronary angiography
1. The left coronary angiogram showed tight stenosis at distal LM trifurcation lesion. ( Movie 1, Movie 2, Movie 3).
2. The right coronary angiogram showed diffuse tight stenosis at proximal to mid RCA and treated using two Promus Element stents ( Movie 4, Movie 5).
An 8 Fr sheath was inserted through right femoral artery and the left coronary ostium was engaged with an 8Fr JL 4.0 catheter with side hole. Three 0.014 inch BMW wires were inserted into the LAD, RI, and LCX, respectively. And then, they performed intravascular ultrasound (IVUS) evaluation from LM to LAD, RI, and LCX, respectively. Before LM treatment, they firstly fixed distal LCX lesion with a Xience Prime stent 2.75 x 23mm. Predilatation was done using a Maverick balloon 2.5 x 15 mm at LM to proximal LAD (Figure 1). And then, the distal LM trifurcation lesion was treated by kissing stenting technique because of a marked size discrepancy between LM and side branches. Two 2.75 x 23mm Xience Prime stents were deployed at LM to proximal LAD and LM to proximal LCX ( Movie 6). In following IVUS evaluation, underexpansion was noted. To get the optimal minimal stent area, kissing balloon technique using a Dura Star balloon 3.0 x 15mm at LAD and a Trek balloon 3.0 x 15mm at LCX was applied (Figure 2). Final angiogram showed a good result ( Movie 7)
yu tao2012-05-29
The final angiogram show a wonderful result,but we will be more worrying about the risk of thrombosis at LM,early or lately。Maybe attempt to the strategy of miniCrush
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