Simple cross over stenting to treat the LMCA disease

- Operator : Marie-Claude Morice

Simple cross over stenting to treat the LMCA disease
- Operator: Marie-Claude Morice, MD

A 69-year-old man was admitted with stable angina pectoris since 1 month. Her coronary risk factors were hypertension, hyperlipidemia and diabetes. The echocardiography showed normal left ventricular function (EF=63%) without regional wall motion abnormality. One month ago, diffuse RCA lesion was corrected with 2 Xience V stent.

Baseline coronary angiography

1. The left coronary angiogram showed significant diffuse long stenosis at LMCA ( Movie 1, Movie 2), diminutive LCX, mild stenotic pLAD and RI.
2. The right coronary angiogram showed patent state at previous site.

Procedure

A 7 Fr XB 3.5 guiding catheter with side hole was engaged in the left coronary artery. LAD and RI were wired with a 0.014 BMW wire respectively. Xience V 4.0x23mm was implanted at LM to pLAD without predilatation. (Figure 1) Voyager NC 4.0x15mm at LM to LAD and Quantum 3.5x15mm at RI were sequentially inflated. And kissing balloon inflation using Voyager NC 4.0x15mm up to 14atm (4.01mm) and Quantum 3.5x15mm up to 14atm (3.54mm) were applied. (Figure 2) Final angiogram showed well-expanded and well-positioned stents without compromised side branch flow. (Figure 3)

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