Simple Stenting for a Distal Right Coronary Quadrifurcation Lesion with Sirolimus-Eluting Stent

- Operator : Seong-Wook Park

Simple Stenting for a Distal Right Coronary Quadrifurcation Lesion with Sirolimus-Eluting Stent
- Operator: Seong-Wook Park, MD
The patient was a 57 year old man with exertional chest pain for 1 year and resting chest pain for 1 month. His risk factors included hypertension and diabetes mellitus. His baseline ECG was normal. His resting LV ejection fraction was 60% with no regional wall motion abnormalities. Baseline coronary angiogram showed a distal right coronary artery (RCA) quadrifurcation lesion (Figure 1, Figure 2).
Procedure
We planned to insert Cypher stents from distal RCA to posterior descending artery (PDA) crossing ostia of other three branches with optional kissing balloon dilatation. An 8F JR4 guiding catheter was engaged at the ostium of the RCA. A 0.014 inch Floppy guide wire and a Choice PT wire were placed into the posterolateral (PL) branch and the PDA, respectively (Figure 3). After predilation with a Stormer balloon (2.5 x 20 mm), two Cypher stents (3.5 x 23 mm at 14 atm to 3.64 mm and 2.75 x 28 mm at 14 atm to 2.86mm) were deployed consecutively at PDA and distal RCA (Figure 4, Figure 5). Then, a choice PT wire was re-introduced into the PL branch through the stent strut for kissing balloon inflation. A Stormer balloon (2.5 x 20 mm) and a maverick balloon (2.5 x 20 mm) was placed at the PDA and PL branch. Then, final kissing balloon inflation was performed (Figure 6 , Figure 7 , Figure 8 ). Although there was a significant compromise of the other branch, no more procedure was done because the branch vessel looked not so big to be treated. The final angiogram revealed optimal stent expansions without significant residual narrowing in both treated branches (Figure 9, Figure 10).

Comments

  • Genshan Ma 2005-04-03 If you put a wire into the second PDA before distal RCA and the big PDA were PCIed, maybe the result might be better.
  • Young-Hak Kim 2005-04-03 Your comment is appropriate. We thought that myocardium supplied by the second PDA was not much as other branches.
  • Jiansheng Wu 2005-04-09 Two stents overlaped at the ostium of 2nd PDA, it might cause some promble. How about a 3.5 x 18 mm stent + a 2.75 x 33 mm stent? Be sure the proximal segment of 2.75mm stent be well dilated.
  • Young-Hak Kim 2005-04-14 We do not have enough data about the impact of stent overlapping. As Dr Wu suggested, we will try to do analyses about the influence of stent overlapping on lesion segment, non-lesion segment, side branch etc.
  • Zheng zhen guo 2005-04-19 Overlapping at bifurcation point is more difficult rewiring and ballooning at side branch after stenting for 2 layers of stent struts, a lucky case.
  • Chen Yung Chih 2005-05-06
  • Tudor C. Poerner, MD 2006-06-16 Upsizing with successive balloon dilations in the distal vessel is sometimes helpful to avoid placement of 2 different stents. Good result, anyway.

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