LAD Bifurcation Stenosis, Treated with IVUS guided SLK-View Bifurcation Stent

- Operator : Alan C. Yeung

LAD Bifurcation Stenosis, Treated with IVUS guided SLK-View Bifurcation Stent

- Operator : Alan C. Yeung, MD

Case Presentation
A 59 year-old man had complaints of exertional angina for 3 months. His coronary risk factor included cigarette smoking. Thallium SPECT showed reversible perfusion defect in LAD territory. Echocardiogram showed normal LV function without regional wall motion abnormality.
Baseline Coronary Angiography
The left coronary angiogram showed tight stenosis in LAD bifurcation with involvement of the ostium of diagonal branch (Figure 1, Figure 2).
Intravascular ultrasound
IVUS examination showed a lot of plaque burden in LAD bifurcation and EEM diameter of 4.4 mm (Figure 3). The ostium of the diagonal branch was also narrowed (Figure 4).
Procedure
An 8 F sheath was inserted through right femoral artery and the left coronary was engaged with an 8 F JL left catheter. LAD and the diagonal branch were wired with two 0.014 inch Floppy wires. Predilation was performed in the diagonal branch (Figure 5) and LAD (Figure 6). Due to sustained narrowing of the lesion (Figure 7), kissing balloon dilatation was performed twice in LAD and the diagonal branch (Figure 8). Before advancement of the stent system into the guiding catheter, the third wire was positioned in the side sheath for access to side branch (Figure 9). After removing the wire advanced in the side branch for predilation, we introduced the delivery system over the wire in the main vessel until the central marker band was aligned to the diagonal branch. Then the wire in the side sheath was passed into the side branch (Figure 10). When the stent system was aligned adequately, the stent was deployed (Figure 11). The SLK-View stent is a new device specially designed to have a side aperture located between the proximal and distal section, allowing access to the side branch after stenting the main branch (Figure 12). Following angiogram showed good stent expansion with sustained narrowing of the diagonal branch (Figure 13). Although IVUS examination after stent deployment showed that the side hole of SLK-View stent was not aligned well with the diagonal branch (Figure 14), kissing balloon dilatation was performed twice with two conventional balloons in LAD and the diagonal branch without difficulty (Figure 15). Because the following angiogram showed good expansion of LAD and the diagonal branch, the procedure was ended without an additional stent implantation in the diagonal branch (Figure 16, Figure 17).

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