Stenting at Ostial Left Anterior Descending Artery Covering Distal Left Main for Complete Lesion Coverage

- Operator : Cheol Whan Lee

Stenting at Ostial Left Anterior Descending Artery Covering Distal Left Main for Complete Lesion Coverage
- Operator: Cheol Whan Lee, MD
Clinical history

A 74 year-old male admitted with stable angina for 6 months. He had hypertension and ex-smoking for coronary risk factors. His baseline ECG was normal. Echocardiography showed good left ventricular function with an ejection fraction of 59%. Thallium SPECT showed reversible perfusion defect in the Left anterior descending (LAD) artery territory.

Baseline coronary angiography

Left coronary angiogram showed a stenosis at ostial LAD (Figure 1, Figure 2). IVUS examination revealed involvement of the distal left main (LM) coronary artery with normal left circumflex artery (LCX) ostium (Figure 3, Figure 4). We intended to treat the lesion with a Cypher stent covering distal LM for complete lesion coverage.

Procedures

A 7F sheath was inserted through the right femoral artery, and the left coronary ostium was engaged with a 7F JL catheter with 4.0cm curve. A 0.014 inch Neos wire was inserted into the LAD. Then, predilation was performed with a 3.0 x 15 mm Maverick balloon at ostial LAD (Figure 5). A 3.5 x 18mm Cypher stent was positioned at the ostial LAD covering the distal LM and deployed by 12 atm (3.5mm) (Figure 6). After stenting, additional balloon dilatation was done with a 4.0?10mm Stomer balloon at 14 atm (4.36mm) (Figure 7). Final angiogram showed a well-expanded stent without residual narrowing or stent jail. (Figure 8, Figure 9).

Follow up coronary angiography

Six-month follow-up angiogram showed a patent stent (Figure 10, Figure 11).

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