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LM Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 73 year-old male patient was admitted for chest discomfort started 1months ago. He had coronary artery bypass graft (CABG) of saphenous vein graft (SVG) to obtuse marginal (OM) at 6th Jan. 2009. Recent coronary angiography from other hospital shown severe stenosis at left main (LM) with near total left circulflex (LCX) ostium occlusion and patent SVG to OM. His coronary risk factor was hypertension, hyperlipidemia, and ex-smoking. The physical exam and electrocardiogram (ECG) was normal. Echocardiography showed ejection fraction 62%.
Baseline Coronary Angiogram
  1. Left and coronary angiogram & IVUS showed severe stenosis at LM to proximal left anterior descending (LAD) with plaque rupture and total occlusion at proximal LCX ( Movie 1).
  2. The right coronary angiogram showed normal coronary angiogram.
  3. Graft angiogram showed patent SVG to OM.
Procedure
A 8Fr sheath was inserted thorough right femoral artery and, left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into LM. Pre-dilation performed with a Raiden3 4.0 x 20 mm balloon ( Movie 2). Orsiro stent 4.0 x 26 mm was successfully deployed at LM ( Movie 3). Additional ballooning was performed by using Raiden3 4.0 x 20 mm balloon at LM ( Movie 4). Final angiogram and IVUS showed that the procedure was successful. ( Movie 5, Movie 6).

Appendix
IVUS image of pre-procedure ( Movie 7) and final image ( Movie 8)
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