Slides Coronary Left Main
LM Trifurcation Disease Teated with Mini-Crushing Technique
- Operator : Runlin Gao
| LM Trifurcation Disease Teated with Mini-Crushing Technique |
| - Operators: Runlin Gao, MD, Duk-Woo Park , MD |
| Clinical presentation |
| A 65-year-old woman was admitted with effort chest pain for 1 year. Her coronary risk factors were Diabetes and hyperlopidemia. Baseline ECG showed normal sinus rhythm. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function. Other non-invasive tests were not done |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed significant stenosis
at left main coronary artery trifurcation site. (Figure
1, Figure
2) |
| Procedure |
| A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr JL guiding catheter with 4.0cm curve. A 0.014 inch BMW wires were inserted into the LAD, LCX and RI(3 wires). IVUS study was done about LCX, LAD and RI. IVUS findings revealed heavy plaque burden in the pLCX, LAD os and distal LM. Initially, we planned to mini-crush technique. We predilated with 2.5 X 15mm Sprinter balloon at pLAD in the first (Figure 3). And then, 3.0 X 18 Xience stent was implanted at pLAD and 3.5 X 18 Xience stent was implanted at pLCX. 4.0 X 23 Xience stent also was inserted at LM to pLAD (Figure 3) . Another 0.014 inch BMW wire was inserted into the LCX. And then additional post-stent balloon dilation was performed with Sprinter 2.0 X 15mm and Maverick 3.0 X15, Maverick at LCX. We performed kissing balloon with 4.0 X 20mm (Figure 4). Dura star at LM-proxmal LAD and 3.0 X 15 mm Maverick at LM-proximal LCX, respectively. Final left angiogram showed that the procedure was successful (Figure 5, Figure 6). |
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