Slides
LM Trifurcation Lesion Treatment Guided by IVUS
- Operator : Seung-Jung Park
LM Trifurcation Lesion Treatment Guided by IVUS |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 75 year-old gentleman was referred for the treatment of known LM disease. About one month ago, he visited another hospital because of effort-related chest pain. At that time, his treadmill test was positive at stage 2, and coronary angiogram showed distal LM trifurcation lesion. CABG was recommended to him, but he refused open heart surgery. His coronary risk factor was current smoking. The physical examination was normal. The ECG showed ST segment depression at lateral leads, but cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=69%) without RWMA. |
Baseline Coronary Angiography |
1. The left coronary angiogram showed significant stenosis at LM trifurcation lesion ( Movie 1, Movie 2, Movie 3). 2. The right coronary angiogram showed nearly normal RCA with collateral flow to LCA ( Movie 4). |
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 three 0.014 inch BMW wires into LAD, LCX, and RI, respectively. Firstly, we performed intravascular ultrasound (IVUS) evaluation from LM to LAD, LCX, and RI respectively (Figure 1). LCX ( Movie 5) and RI ( Movie 6) ostia were relatively preserved at IVUS examination. So, we planned to deploy a stent at LM to proximal LAD with simple cross-over technique. Predilatation was performed using a TREK 2.5x15mm balloon (Figure 2). We deployed a Promus Element 3.5x38mm stent at LM to proximal LAD with additional balloon dilatations using stent balloon (Figure 3, Figure 4). After stenting, angiogram showed discrete narrowing of RI ostium ( Movie 7). So we checked the FFR value of RI to evaluate the functional significance. The FFR value of was 0.86. Final angiogram showed that the procedure was successful ( Movie 8, Movie 9). |
Leave a comment
Sign in to leave a comment.
Comments