Left Main and mid LAD Trifurcation Lesion Treated by Simple Cross-Over Stenting

- Operator : Thierry Lefevre

Left Main and mid LAD Trifurcation Lesion Treated by Simple Cross-Over Stenting

- Operators: Thierry Lefevre, MD, Joo-Young Yang, MD

Case Presentation

A 76 year-old female was admitted with effort chest pain for a one month. Her coronary risk factors were hypertension, and hyperlipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=62%) without RWMA. Treadmill excercise test was positive at stage II.

Baseline Coronary Angiogram

1. The left coronary angiogram showed significant diffuse stenosis at proximal to mid LAD and the diagonal branch ( Movie 1, Movie 2). 2. The right coronary angiogram showed no significant stenosis ( Movie 3).

Procedure

A 7 Fr XB 3.0 guiding catheter with side hole was engaged into left coronary artery through right femoral approach. One 0.014 inch Fielder FC and two 0.014 inch BMW wires were placed into the LAD and two diagonal branch, respectively. They performed predilatation at proximal to mid-LAD with an Empira NC 2.5 x 15mm and then deployed a Xience Prime stent 2.5 x 28mm at mid LAD (Figure 1). Post-stenting adjunctive balloon dilatation was performed at mid LAD and diagonal branch with a Quantum 2.75x8mm and a Summit 2.0 x 15mm, respectively. And then they deployed a Xience Prime stent 2.7 5x 33mm at Left main (LM) to proximal LAD (Figure 2). Post-stenting adjunctive balloon dilatation was performed at LM to proximal LAD with an Empira NC 3.0 x 15mm balloon. They performed additional kissing balloon with an Empira NC 3.5x15mm balloon at LM to proximal LAD and Empira NC 3.0 x 15mm balloon at LM to proximal LCX (FFigure 3). Finally, They performed kissing balloon with an Empira NC 3.0 x15mm balloon at mid-LAD and a Summit balloon 2.0x15mm at diagonal branch (Figure 4). Actually, another diagonal branch ostium was revealed significant stenosis, rewiring was impossible. So, they decided to treat medical treatment on diagonal ostium. Final angiogram showed relatively good result ( Movie 4, Movie 5).