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Left Main Disease with RCA CTO lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 59 year-old gentleman was admitted for several months of effort angina. Physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=64%) without regional wall motion abnormality. The result of treadmill test was positive at recovery phase.
Baseline Coronary Angiogram
  1. A left coronary angiogram showed significant narrowing of LM ostium and mild disease on proximal to mid LAD, with grade 3 collaterals to RCA ( Movie 1)
  2. A right coronary angiogram showed total occlusion at proximal RCA ( Movie 2)
Procedure
We decided to to perform intervention at left main to proximal LAD firstly, and then treat proximal RCA CTO lesion. Two 8 Fr sheath was inserted in to both femoral arteries, and the left coronary ostium was engaged with an 8 Fr JL 4.0 catheter with side hole. From proximal LAD to LM, FFR was checked 0.70 after 140mcg/kg/min IV adenosine (Figure 1). We advanced BMW 0.014-inch guidewire in to LAD and implanted Resolute stent 4.0 x 23 mm at left main to proximal LAD (Figure 2). Post-stenting adjunctive balloon dilatation using Stent balloon (Figure 3). We check angiogram and proximal LCx showed good patency ( Movie 3). And then, we moved on the RCA CTO lesion. 8 Fr JR 4.0 catheter was engaged on RCA and 6 Fr JL 4.0 catheter was exchanged for LCA. Firstly, Sion blue was anchored on cornus branch with Crusade support, Gaia 2 was attempt for antegrade approach (Figure 4). Fortunately, Gaia 2 passed through the totally occluded lesion ( Movie 4), and the lesion was dilated with Maverick 2.0 x 15 mm balloon for several times (Figure 5). Two resolute stents 3.0 x 38 mm and 3.5 x 38 mm was implanted sequentially (Figure 6). Final angiogram showed that the procedure was successful ( Movie 5).
Kunal Bikram Shaha2016-07-28
A great academic contribution by summit md team esp spreaheaded by Sir Seung-Jung Park...Thankyou very much sir .You make left main look so simple.
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