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LAD PCI with DEB at Diagonal Branch and Final Kissing
- Operator: Seung-Jung Park, MD
Case Presentation
A 65 year-old male patient was hospitalized for effort chest pain started 2 months ago. He had diagonal branch stenting 16 years ago at the other hospital. ECG showed no abnormal findings.
Baseline Coronary Angiogram
  1. Left coronary angiogram showed tight stenosis at the proximal LAD with trifurcation. The first diagonal branch showed Instent-restnosis(ISR). ( Movie 1, Movie 2)
  2. The right coronary angiogram showed mild disease. ( Movie 3)
Procedure
An 8 Fr sheath was inserted thorough the right femoral artery and left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. First, a 0.014-inch BMW wire was inserted through diagonal branch and 0.014-inch Runthrough wire into the LAD. Balloon dilation with an Emerge 2.5 x 15 mm at the diagonal branch was done first and IVUS was done, showing ISR at diagonal branch. ( Movie 4) Then additional balloon dilatation was performed with a Raiden 3.0 x 15 mm and drug-eluting balloon was applied at the ISR lesion. (Figure 1) The next step was expanding the proximal to mid LAD lesion with a Sapphire NC 3.5 x 15 mm balloon. We implanted a Xience Alpine stent sized 3.5 x 38 mm into the LAD lesion and post-balloon dilatation was done with a Sapphire NC 4.0 x 18 mm. (Figure 2) The final kissing balloon was performed with a Sapphire NC 3.5 x 15 mm at the LAD upto 8 atm (diameter 3.39) and Raiden 3.0 x 15 mm at diagonal branch upto 8 atm (diameter 2.86). (Figure 3) The final angiogram showed a successful result. ( Movie 5, Movie 6)
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