LM Bifurcation ISR Lesion Treated by Drug Eluting Balloons

- Operator : Seung-Jung Park

LM Bifurcation ISR Lesion Treated by Drug Eluting Balloons
- Operator: Seung-Jung Park, MD
Case Presentation
A 56 year-old woman was admitted with effort related chest pain for one month. About two years ago, he had got PCI for LMos to proximal LAD lesion at another hospital (Pico elite 3.5 X 34mm). His coronary risk factors were hyperlipidemia, and ex-smoking. The physical examination was unremarkable. The ECG and cardiac enzymes were normal. The echocardiography showed normal LV systolic function (EF=64%) without regional wall motion abnormality.
Baseline Coronary Angiography
1. Left coronary angiogram showed tight ISR lesions at LM to pLAD and discrete tight stenosis of LCX ostium( Movie 1, Movie 2).
2. The right coronary angiogram showed no significant lesion ( Movie 3).
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 Sion wire into LAD and aonther 0.014 inch Sion wire into LCX, respectively (Figure 1). At first, proximal LCX was dilated with a 2.5 X 20 mm Maverick balloon (Figure 2). And then, LM lesion was predilated with a 3.0 X 10 mm Cutting balloon (Figure 3). And then, we predilated LM to proximal LAD lesion with a 3.5 X 10 mm Cutting balloon again (Figure 4). Next, LM to proximal LCX lesion was dilated with 3.5 X 20 mm Dura star balloon (Figure 5), and proximal LCX with 3.5 X 20 mm Pantera balloon sequentially (Figure 6). We performed kissing balloon technique with a 3.5 X 20 mm Empira NC balloon at LM to proximal LAD and a 3.5 X 20 mm Pantera balloon at LM to proximal LCX, respectively (Figure 7). Finally, we performed balloon angioplasty with a 3.5 X 20 mm SeQuent Please drug eluting balloon at LM to proximal LCX (Figure 8) and a 3.5 X 30mm SeQuent Please drug eluting eluting balloon at LM to proximal LAD (Figure 9), respectively, and then kissing balloon technique was done with same balloons at same lesions (Figure 10). Final left coronary angiogram showed no residual in-stent narrowing in both branches( Movie 4, Movie 5).

Comments

  • Garry Barron 2012-12-30 Is a repeat angiographic follow up planned?
  • Vijay Shah 2012-12-30 IVUS exam post -ptca would have helped to assess the final MLD and prescence of recoil,dissection......DR V T SHAH

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