Slides Coronary Left Main
LM Bifurcation Disease
- Operator : Eberhard Grube
| LM Bifurcation Disease |
| - Operators: Eberhard Grube, MD, Huay Cheem Tan, MD |
| Clinical presentation |
| A 56-year-old woman was admitted with DOE &
chest pain for 2 years. CT revealed abnormalites on her coronary artery.
ECG showed non-specific finding, and biomarker was within normal range.
Stress test was not done. She underwent stenting at proximal to mid RCA
using 3.5 x 23 mm and 2.75 x 33 mm Cypher stent. She has a history of
diabetes and dyslipidemia. |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed 60% narrowing
of distal LM to LCX ostium, diffuse 70-80% narrowing of proximal to distal
LCX, and diffuse 60-80% narrowing of mid LAD. (Figure
1, Figure2,
Figure
3). |
| 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 4.0 cm curve. A 0.014 inch BMW wires were inserted into the LAD and LCX. IVUS study was done about distal LM, ostium to distal LCX and LAD. IVUS study revealed heavy plaque burden at LCX os and mid LAD. Initially, proximal to distal LCX was predilated with 3.0 x 15 Voyager balloon. And then, 3.5 x 18 mm Cypher stnet was deployed at proximal to distal LCX (Figure 4). And subsequently, mid LAD was also predialted with 3.0 x 15 Voyager balloon. Cypher stent 3.0 x 33 was deployed at mLAD across diagonal branch with protection using 0.014 inch B MW wire. (Figure 5). Finally, 3.5 x 18mm Cypher stent was also deployed at distal LM to proximal LCX across the LAD. Final angiogram showed excellent result. (Figure 6, Figure 7) |
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