The Treatment of ISR at dLM Bifurcation using Drug Eluting Balloon

- Operator : Seung-Jung Park

The Treatment of ISR at dLM Bifurcation using Drug Eluting Balloon
- Operator: Seung-Jung Park, MD
Clinical Presentation
A 66 year-old man was admitted with DOE(NYHA II).. Eight months ago, he had got PCI on LADos to mid LAD (Promus 2.75 x 18mm+2.75 x 18mm+2.5 x 23mm), dLM to pLCX (Promus 3.5 x 15mm) at outside hospital. His coronary risk factors were smoking and dyslipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality.
Baseline Coronary Angiogram
1. The left coronary angiogram showed tight ISR of dLM bifurcation.( Movie 1)
2. The right coronary angiogram showed intermediate disease.( Movie 2)
Procedure
An 8Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8Fr JL4 SH guiding catheter. A 0.014-inch BMW -190cm wire were inserted into the LAD and LCX respectively.(Figure 1) After IVUS examination, pLAD was predilated with 2..5 x 15mm Maverick balloon. and then we performed kissing balloon dilatation with 2.5 X 15mm Maverick balloon at pLAD and 2.5 X 15 mm Dura Star balloon at pLCX respectively. LM to pLAD and LM to pLCX were predilated with 3.0X15mm Voyager NC and 2.5X15mm Dura Star balloon respectively. And kissing balloon technique was done with same balloon and lesion.(Figure 2) Finally, we performed kissing balloon with 3.0 X 20mm SeQuent Please drug balloon at LM to proximal LAD and 3.0 X 17 mm SeQuent Please drug balloon at LM to proximal LCX respectively.(Figure 3) Final left coronary angiogram showed no residual in-stent narrowing in both branches.( Movie 3)

Comments

  • Anlin Lv 2011-05-08 It is a too ease case
  • Fadili 2011-07-30 Great job, excellent result.

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