Kissing Stenting for the LM Bifurcation Lesion

- Operator : Seung-Jung Park

Kissing Stenting for the LM Bifurcation Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 73-year-old female has had a PCI at the distal RCA due to STEMI and was admitted for evaluation of remnant diseases. The recent coronary angiography from the other hospital showed the short left main (LM), severe stenosis at the proximal left anterior descending artery (LAD) and left proximal circumflex artery (LCX). Her coronary risk factor was hypertension. The physical exam was unremarkable, the echocardiography showed preserved ejection fraction (LVEF 55%) with regional wall motion abnormality of the mid-lateral wall and apical inferior wall.
Baseline Coronary Angiogram
  1. The left coronary angiogram & IVUS showed significant stenosis at the proximal LAD and LCX with very short LM ( Movie 1, Movie 2).
  2. The right coronary angiogram showed patent previous stent and mild stenosis at the middle RCA ( Movie 3).
Procedure
An 8Fr sheath was inserted through the right femoral artery with an 8 Fr JL 5 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into the LAD and LCX. Predilatation performed with a Sapphire NC 2.5 x 18 mm balloon ( Movie 4, Movie 5). Two Xience Alpine 3.0 x 33 mm and 2.5 x 33 mm were deployed at the LAD and LCX simultaneously ( Movie 6). The kissing ballooning was performed by Nimbus Salvo 3.5 x17 mm and Sapphire NC 3.0 x 15mm balloon at pLAD and pLCX ( Movie 7). The final angiogram and IVUS showed successfully implanted stents ( Movie 8).

Appendix
IVUS image of pre-procedure ( Movie 9) and final image ( Movie 10, Movie 11).

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