A 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 8Fr JL 4 catheter with side hole. Three 0.014 inch BMW wires were inserted into the LAD, LCX, and Diagonal branch. We pre-dilated diagonal branch using a Maverick 2.0 x 15 mm balloon. A 2.5 x 18mm XIENCE Prime stent was directly implanted at diagonal branch LM to proximal LAD crossing LCX ostium without predilatation (Figure 1, Movie 4). And then, we pre-dilated mLAD using a Maverick 2.5 x 15 mm balloon. Thereafter, we deployed a XIENCE Prime 3.0 x 18mm at mLAD (Figure 2). After mLAD stenting, we checked LAD FFR value using a pressure wire. LAD FFR value was 0.74. Therefore, we deployed a XIENCE Prime 4.0 x 23mm at LM ostium to pLAD (Figure 3). Adjunctive post-stenting balloon dilatation was done using a Dura Star 4.0 x 15mm at LM to pLAD. After LM to pLAD stenting, LAD FFR value was 0.88. Final angiogram showed that the procedure was successful ( Movie 5, Movie 6). |
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