Case

Short LM with Bifurcation Disease Treated by Kissing Stent Technique

- Operator : Seung-Jung Park

Short LM with Bifurcation Disease Treated by Kissing Stent Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 44 year-old female was admitted with effort chest pain for 4 months. Her coronary risk factor was hypertension. The physical examination was normal and both baseline ECG and cardiac markers were unremarkable. The echocardiography showed normal LV systolic function (EF=64%) without regional wall motion abnormality. Thallium test showed reversible medium sized perfusion defect at LAD territory.
Baseline Coronary Angiography
The left coronary angiography showed short LM with bifurcation disease. Discrete lesion with 50% stenosis of dLM was observed and disease was extended to LAD ostium with 90% stenosis and LCX ostium with 60% stenosis. There was no change with administration of intra-coronary nitroglycerin (Figure 1, Movie 1).

Otherwise, there was no significant stenosis on the right coronary angiogram.
Procedural Steps
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL 4.0. 0.014-inch 190cm BMW wire was inserted into the LAD and another 0.014-inch 190cm BMW wire was inserted into the LCX ( Movie 2). We checked the IVUS and confirmed short length of LM and atherosclerotic bifurcation disease. A Xience Xpedition 3.0 X 15 mm Stent was positioned in LM to proximal LAD and another Xience Xpedition 2.5 X 15 mm Stent was positioned in LM to proximal LCX. The LM to pLAD and pLCX stents were successfully deployed by kissing stent technique (Figure 2, Movie 3). Additional kissing ballooning was performed by using a Powered Lacrosse 3.5 X 15 at LM-pLAD and Empira NC 2.75 X 15mm at LM-pLCX ( Movie 4). Final left angiogram and IVUS showed that the procedure was successful ( Movie 5, Movie 6).

Comments

  • Richard Chan 2014-12-13 Would there be a metal carina in the left main?
  • Young-Hak Kim 2014-12-15 Dr. Chan, please explain the meaning of 'metal carina'.
  • Kunal Bikram Shaha 2016-07-28 Sir may I know what is the criteria to Choose guide in left main,JL or xtraback up? why didnt you choose the minicrush technique in this case sir.Flow rheology in left main is better in minicrush than kissing stent...Is it because the let main is too short........
  • Se Hun Kang 2016-07-28 Thank you for your comment. When choose guiding catheter, we consider morphology of aorta and LM ostium and the lesion characteristics. As you mentioned, left main was too short. So it was hard to consider crush technique as two stent technique in this case
  • Kunal Bikram Shaha 2016-07-28 Can you please illustrate what type of guiding in which case...it would be help for all the beginners like me
  • Se Hun Kang 2016-07-28 Thank you for your comment. It`s hard to simply illustrate the selection of guiding catheter. You might have lost of information about selection of guiding catheter in most textbooks and sufficient experience is required for proper clinical decision. I hope this helps you with daily clinical practice.

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