Slides Endovascular Renal
Percutaneous Intervention for Left Main Chronic Total Occlusion and Concomitant Right Coronary Artery and Renal Artery Stenosis
- Operator :
Percutaneous Intervention for Left
Main Chronic Total Occlusion and Concomitant Right Coronary Artery and
Renal Artery Stenosis |
- Operator: Zhang Oi, MD |
Clinical Presentation |
A 60-year old man was admitted due to effort chest pain for 2 months. His coronary risk factors were hypertension, hyperlipidemia, smoking, and chronic renal dysfunction. Baseline ECG showed a ST depression at Lead I, aVL, V2~V6. Echocardiography revealed a normal systolic function without regional wall motion abnormality. |
Baseline Coronary Angiogram |
1. Left coronary angiogram showed a total occlusion
of left main coronary artery (LMCA) ostium with TIMI 0 flow (Figure
1). |
Procedure |
A 7F JL 4.0 guiding catheter was engaged to the LM ostium via right femoral artery, and 6F JR 3.5 diagnostic catheter was placed to provide collateral image of left coronary vessels through left femoral artery. After then, HT Pilot 200 wire was firstly tried and crossed the occlusion segment, reached the D1 branch through the contralateral angiogram (Figure 5). A second guide wire (PT-GRAPHIX, Boston Scientific) was successfully placed into left circumflex artery (LCX) (Figure 6), and a third wire (HT Pilot 150) crossed the left anterior descending artery (LAD). The first wire in the D1 was then removed (Figure 7). After predilatation (Maverick 2.0 X 20 mm) of LAD and LCX (Figure
8), two Cypher stents were placed into the LCX (2.5 X 23 mm) and LAD
(3.0 X 28 mm), respectively (Figure
9) and then deployed with crush technique (Figure
10, Figure
11, Figure
12). Final kissing balloon dilation was performed (LAD: 3.0 X 20 mm
Sequent upto 12 atm, LCX: 2.5 X 20 mm Maverick upto 12 atm) (Figure
13, Figure
14). The D1 ostium was finally dilated with a 2.0 X 20 mm balloon
at 12 atm (Figure
15). Postprocedural angiogram showed good results (Figure
16). |
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