LAD Bifurcation Lesion Treated by Single Stent Placement

- Operator : Ron Waksman

LAD Bifurcation Lesion Treated by Single Stent Placement
- Operators: Ron Warksman, MD, Jong-Young Lee, MD
Case Presentation
A 67-year old gentleman was referred to our hospital for the PCI of LAD bifurcation lesion. He has been managed as stable angina with medical treatment for one year. However, his chest pain was recently aggravated. His coronary risk factors were hypertension and hyperlipidemia. The ECG and cardiac enzymes were unremarkable. Thallium SPECT showed reversible large size perfusion defect in LAD territory, and treadmill test was positive at stage 3.
Baseline Coronary Angiography
1. The left coronary angiography revealed significant stenosis at mid LAD bifurcation lesion with Medina classification (1,1,1) ( Movie 1).
2. The right coronary angiogram was normal.
Procedure
A 7 Fr EBU 3.5 guiding catheter with side holes was engaged at the left coronary artery ostium. They checked mLAD FFR value using a pressure wire and mLAD FFR value was 0.67. A 0.014 inch BMW wires were placed into the LAD. And another wire were tried to place into diagonal branch, but it was failed due to the acute angulation of diagonal ostium (Figure 1). After the several trial, they decided to do single stent placement covering the side branch because the ostium of diagonal branch seems to be preserved relatively in angiogram. They deployed a Promus Element 3.5 x 28mm stent at pmLAD (Figure 2). Then they performed intravascular ultrasound evaluation at LAD. The final angiogram showed that procedure was successful ( Movie 2).

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