Slides Coronary Left Main

LM Bifurcation (Cross)

- Operator : Martin Bert Leon

LM Bifurcation (Cross)
- Operators: Martin B. Leon, MD, June Hong Kim, MD
Clinical Information

- Relevant clinical history and physical exam:
A 60-year-old woman was admitted with effort chest pain for one year. Routine health check revealed abnormal finding on treadmill test. ECG showed non-specific finding, and biomarker was within normal range. She had no major cardiovascular risk facotors.

- Relevant test results prior to catheterization:
Treadmil test revealed pathologic ST depression with symptom at stage 2. Echocardiography showed normal LV systolic function and normal regional wall motion.

- Relevant angiography findings:
Coronary angiogram showed a significant multiple stenosis at left main coronary artery bifurcation site (Figure 1), mid LAD (Figure 2), distal LCX (Figure 3) and also showed severe stenosis from ostium to middle RCA. A RCA lesion was treated by two Cypher at two months ago.
Interventional Management
- Procedural step:
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr EBU guiding catheter with 3.5cm curve. A 0.014 inch BMW wires were inserted into the LAD and LCX respectively. IVUS was performed about LAD, and LCX lesions. IVUS findings revealed heavy plaque burden in the LCX ostium and mid LAD lesion was more severe than angiographic finding. At first, an Endeavor resolute 3.0 x 18 mm stent were directly implanted at mid LAD (Figure 4), and an Endeavor resolute 2.5 x 18 was implanted at distal LCX after predilatation. We decided to deploy just one stent at LM to LCX lesions. An Endeavor 3.0 x 30 was implanted at LM lesion (Figure 4) and kissing balloon was performed for jailed LAD ostial lesion (Figure 5). Final left angiogram showed that the procedure was successful (Figure 5).

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