Simple stenting at severe stenosis in the pLAD and diffuse moderate stenosis in the LCX

- Operator : Bernhard Meier

Simple stenting at severe stenosis in the pLAD and diffuse moderate stenosis in the LCX
- Operator: Bernhard Meier, MD

A 57-year-old male was admitted with recurrent chest pains in sleeping. He had no prior PCI history and a habit of smoking and been on medication for hypertension. His ECG and cardiac biomakers were normal. Echocardiography showed a LVEF 61% without regional wall motion abnormality.

Baseline coronary angiogram

1. A right angiogram showed mild stenosis of proximal and mid RCA.(Figure 1)
2. A left coronary angiogram showed diffuse significant stenosis in the LCX proximal to OM branch and severe stenosis of short segment in the proximal LAD.(Figure 2, Figure 3, Figure 4)

Procedure

A 7 Fr JL 4 with side-hole guiding catheter was engaged into left coronary artery. The LCX was crossed with 0.014¡± Floppy BMW guidewire firstly. The LCX lesion was predilated with a 3.0 * 20 mm Maverick balloon at two times with concurrent contrast injections.(Figure 5) A 3.0 * 23 mm Xience V stent was deployed in the LCX.(Figure 6) After placing the BMW guidewire into the LAD, the pLAD lesion was predilated with previously-used Maverick balloon. A 3.5 * 12 mm Xience V stent was deployed from the distal LM to the pLAD across the LCX ostium.(Figure 7) After stenting, the angiogram showed a compromised LCX ostium.( Movie 1) A additional balloon dilatation was planed to optimize the ostium of LCX. The previously-used Maverick balloon could not pass the LCX ostium, a 2.5 * 15 mm Maverick balloon (new one) was used for adjunctive balloon dilatation at 18 atm. (Figure 8) Final angiogram showed a good result.(Figure 9)

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