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Distal LM Bifurcation ISR Lesion Treated by Drug Eluting Balloons
- Operator: Seung-Jung Park, MD
Case Presentation
A 50 year-old gentleman was admitted with effort related chest pain for one month. About ten months ago, he had got PCI for LM lesion with crush technique at our hospital (Resolute integrity 3.5 X 20mm and 3.0 X 20mm at LM to mid LAD and Resolute integrity 3.0 X 22mm at distal LM to proximal LCX). His coronary risk factors were hypertension, hyperlipidemia, and current smoking. The physical examination was unremarkable. The ECG and cardiac enzymes were normal. The echocardiography showed normal LV systolic function (EF=57%) without regional wall motion abnormality.
Baseline Coronary Angiography
1. Left coronary angiogram showed tight ISR lesions at distal LM bifurcation ( Movie 1).
2. The right coronary angiogram showed no significant lesion ( Movie 2).
Procedure
An 8 Fr JL 4 guiding catheter with side holes was engaged at the left coronary artery ostium through right femoral artery. We inserted a 0.014 inch Soft wire into LAD and a 0.014 inch Kinetix wire into LCX, respectively (Figure 1). At first, LM to proximal LAD lesion was predilated with a 3.0 X 10 mm Cutting balloon (Figure 2). And then, we predilated LM to proximal LCX lesion with a 3.0 X 15 mm Dura Star balloon (Figure 3), because the Cutting balloon failed to pass into the LCX. Next, we performed kissing balloon technique with a 3.5 X 15 mm Dura Star balloon at LM to proximal LAD and a 3.0 X 15 mm Dura Star balloon at LM to proximal LCX, respectively (Figure 4). Finally, we performed balloon angioplasty with a 3.0 X 20 mm SeQuent Please drug eluting balloon at LM to proximal LCX (Figure 5) and a 3.5 X 20mm SeQuent Please drug eluting eluting balloon at LM to proximal LAD (Figure 6), respectively, and then kissing balloon technique was done with same balloons at same lesions (Figure 7). Final left coronary angiogram showed no residual in-stent narrowing in both branches ( Movie 3).
Arash Gholoobi2012-11-05
What about IVUS? What do you think about the mechanism of restenosis? What is your opinion about final short NC balloon dilatation after kissing balloon inflation to correct the ovalisation?
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