Slides Coronary Bifurcation

Proximal LAD Bifurcation Lesion Treated with Simple Cross-Over Technique Using Single Drug-Eluting Stent

- Operator :

Proximal LAD Bifurcation Lesion Treated with Simple Cross-Over Technique Using Single Drug-Eluting Stent
- Operators: Patrick W. Serruys, Nae Hee Lee, MD
Clinical presentation

A 56-year-old man had admitted with effort chest pain for 6 month. Since last months, he suffered from crescendo chest pain. ECG showed non-specific finding, and biomarker was within normal range. Echocardiography showed normal LV systolic function (EF = 66%).
Baseline coronary angiogram

1. Left coronary angiogram showed significant tight narrowing of proximal LAD and diagonal true bifurcation site. Left main coronalry artery shows huge big diameter. (Figure 1, Figure 2)
2. Right coronary angiogram was normal

Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 4.0 cm curve. 0.014 inch BMW wires were inserted into the LAD and 0.014 inch Choice PT wire were inserted into the D1, respectively. Initially, first big diagonal were predilated with 2.5 X 15 mm Avita balloon and then proximal to mid LAD were pre-dilated with 2.5 X 15 Ryujin balloon sequentially (Figure 3, Figure 4). A 4.5 X 16 mm Taxus liberte stent was placed at proximal to mid LAD and deployed at 16 atm (5.08 mm) (Figure 5, Figure 6). And then, Kissing balloon between proximal LAD with 2.5 X 15 Ryujin and big diagonal with 2.5 X 15 Avital NM balloon (Figure 7). Post-stent IVUS revealed satisfactory result without malapposition of the stent. Final angiogram showed a well-expanded stents without residual narrowing (Figure 8, Figure 9)

Comments

  • azhar 2009-05-03 why not to keep it simple and just stent the LAD and leave dignonal as such .In any case restenosis in side branch is very high after ballooning. Azhar
  • yan yan 2009-05-04 you bet, Dr. Azhar
  • curtis 2012-01-21 i totally agree with azhar, moreover, the stenosis of lcx in future is much more concerned. why do you think of covering lcx?

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