Slides

IVUS Guided Distal LM Trifurcation Treatment Confirmed by FFR

- Operator : Seung-Jung Park

IVUS Guided Distal LM Trifurcation Treatment Confirmed by FFR
- Operator: Seung-Jung Park, MD
Case Presentation
A 72 year-old gentleman was admitted with dyspnea on exertion developed one year ago. His coronary risk factors were hypertension, dyslipidemia, and ex-smoking. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=67%) without regional wall motion abnormality. Treadmill test was positive at stage 3.
Baseline Coronary Angiography
1. The left coronary angiogram showed severe stenosis with ulcerative lesions at distal LM trifurcation ( Movie 1, Movie 2, Movie 3).
2. The right coronary angiogram was nearly normal ( Movie 4).
Procedure
Nine and Eight Fr sheaths were inserted into left and right femoral artery, respectively. Firstly, we placed prophylactic IABP in the descending aorta through left femoral artery and started with 2:1 pumping. An 8 Fr JL 3.5 guiding catheter with side holes was engaged at the left coronary artery ostium through right femoral artery. We inserted two 0.014 inch BMW wires into LAD and LCX, respectively (Figure 1). And then, we performed IVUS examination to take accurate information, especially for the LCX ostium. LCX and RI ostia were relatively preserved at LCX IVUS examination ( Movie 5). Therefore, we decided to treat the lesions with simple cross-over stenting. Predilatation was performed using a Black Hawk 2.5x20mm balloon at LM to proximal LAD (Figure 2). And then we deployed a Xience Prime 3.5x33mm stent (Figure 3). Additional balloon dilatations were performed using Quantum 5.0x15mm balloon (Figure 4). After stenting, we checked the FFR values of LCX and RI using a pressure wire. The FFR values of LCX and RI were 0.92 and 0.84, respectively. Final angiogram showed that the procedure was successful ( Movie 6, Movie 7).

Comments

  • Dr Joy Sanyal 2013-04-30 dr park i was keen to know at pressure you have dilated the LM with the 2.5 balloon and also the post dilatation pressures.

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