Slides
Left Main Bifurcation Stenosis Treated with Simple Cross-over and Final Kissing Balloon Technique
- Operator : Seung-Jung Park
| Left Main Bifurcation Stenosis Treated with Simple Cross-over and Final Kissing Balloon Technique |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| This 62-year old woman was admitted to our hospital for treatment of alleged left main (LM) coronary artery disease. She had a history of ischemic heart disease and received PCI at proximal to mid-portion of LAD and proximal portion of LCX in 2012 at outside hospital. Chest pain on exertion, that led her to undergo coronary angiography at outside hospital, developed 2 months ago. |
| Baseline Coronary Angiography |
The left coronary angiogram showed significant narrowing at proximal LAD. This lesion was in communication with distal LM and proximal LCX ( Movie 1, Movie 2). The right coronary angiography revealed non-significant stenosis at the proximal and distal portion ( Movie 3). |
| Procedure |
| A 5 and 8 Fr sheaths were inserted into the left and right femoral arteries, respectively. After introducing the 0.014 inch-190cm BMW PCI guidewires into the LAD and LCX sequentially (Figure 1), lesion character was identified with IVUS evaluation from the LCX to LM. Since LCX ostium was relatively preserved, we predilated the LAD and LM lesion with a Maverick 2.5 x 20 mm balloon (Figure 2) and thereafter, the Promus Premier stent 3.5 x 24 mm was deployed making the stent cross over from proximal LAD to LM. Because the stent was under-expanded due to calcification, further dilatation was done using Empira NC 3.5 x 20mm balloon (Figure 3, Figure 4). Follow-up angiogram showed progressed stenosis at the ostium of LCX ( Movie 4). After rewiring the LCX with 0.014 inch-182cm Choice PT guidewire (Figure 5), balloon dilation with a Maverick 1.5 x 15 mm, Quantum 2.75 x 20mm was done (Figure 6, Figure 7). Additional dilatation with an Empira NC 3.5 X 20 mm at the LM to LAD was done, and final kissing balloon dilatation was performed with an Empira NC 3.5 X 20 mm at the LM to LAD and a Quantum 2.75 X 20 at the LCX (Figure 8). Final angiogram showed well-expanded and well-positioned stents ( Movie 5, Movie 6, Movie 7). |
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