|Short LM with Bifurcation Disease Treated by Kissing Stent Technique|
|- Operator: Seung-Jung Park, MD|
|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.
|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).|