V Stenting Technique to High Diagonal and LAD Bifurcation Lesion

- Operator : Seung-Jung Park

V Stenting Technique to High Diagonal and LAD Bifurcation Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 63 years old male patient visited to outpatient clinic for EKG abnormality which was detected during medical check-up. His EKG showed left ventricular hypertrophy with diffuse ST-T wave change. His echocardiogram revealed nonobstructive hypertrophic cardiomyopathy with normal systolic function and coronary CT angiography showed severe stenosis of diagonal branch and distal LCX. He underwent coronary angiogram and CAG showed tight stenosis at pLAD and high diagonal bifurcation and dLCX. FFR was done in LAD, High Diagonal branch and LCX and FFR values were 0.72, 0.70 and 0.89, respectively. We planned to treat LAD and High Diagonal branch lesions.
Baseline Coronary Angiogram
  1. The right coronary angiogram was near normal ( Movie 1).
  2. The left coronary angiogram showed tight stenosis of the proximal LAD and high diagonal artery. The distal LCX also had diffuse stenotic lesion but FFR was negative ( Movie 2, Movie 3, Movie 4).
Procedure
An 8 Fr long sheath was inserted through the right femoral artery and left coronary artery was engaged with an 8 Fr JL4 guiding catheter. The wire, 0.014-inch BMW wire was inserted into the LAD and High Di and IVUS was performed ( Movie 5, Movie S1, Movie S2). We decided to perform V stenting for LAD and high diagonal bifurcation with a large proximal main branch and with a <90 degree distal angle. High Di was dilatated with 3.0 x 15 mm NC balloon ( Movie 6). Then Resolute Onyx 3.0 x 18mm stent was placed in High Di and Resolute 3.5 x 15 mm stent was placed in pLAD ( Movie 7). After checking the position of two parallel stents covering both branches and extending into the main branch, the stent of high Di was deployed and then, the stent of LAD was deployed, subsequently ( Movie 8, Movie 9). After several non-compliance post-balloon dilatation were applied at high DI and LAD with 3.0 x 15 mm, 3.5 x 15 mm NC balloon, final kissing ballooning was performed ( Movie 10). Final angiogram and IVUS showed optimal stent area without protrusion of stent strut into LM ( Movie 11, Movie 12, Movie S3)

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