LM to Diagonal Stenting After CABG

- Operator : Seung-Jung Park

LM to Diagonal Stenting After CABG
- Operator: Seung-Jung Park, MD
Case Presentation
A 69 year-old male patient was admitted for chest discomfort started 1 month ago. He had coronary artery bypass graft (CABG) with right gastroepiploic artery to posterior descending artery (PDA) in 2003. Redo-CABG wad done with left internal mammary artery (LIMA) to left anterior descending (LAD) and free radial artery (fRA) to obtuse marginal artery (OM) at 20th Nov. 2008. His coronary risk factors were hypertension, diabetes, and hyperlipidemia. The physical exam and electrocardiogram were unremarkable. Echocardiography showed akinesia of inferoposterior wall with ejection fraction of 52%. Thallium SPECT showed reversible large sized decreased perfusion in apical lateral and mid-basal anterolateral wall.
Baseline Coronary Angiogram
  1. Left and coronary angiogram showed severe stenosis at left main (LM) to LAD and diagonal branch ( Movie 1).
  2. The right coronary angiogram showed total occlusion at mid right coronary artery (RCA) with bridging collateral ( Movie 2).
  3. Graft angiogram showed patent LIMA to LAD ( Movie 3) and fRA to OM ( Movie 4).
Procedure
7Fr sheath was inserted thorough right femoral artery and, left coronary artery was engaged with a 7 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into LM to diagonal branch. Pre-dilation performed with a NC TREX 2.5 x 20 mm balloon ( Movie 5). Resolute Onyx stent 2.5 x 18 mm and 3.5 x 30mm was successfully deployed at LM to diagonal branch ( Movie 6, Movie 7). Additional ballooning was performed by using NC TREX 2.5 x 20mm and Sapphire NC 3.5 x 15mm balloon at LM to diagonal branch ( Movie 8, Movie 9). Final angiogram showed that the procedure was successful ( Movie 10).

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