We planned to insert Cypher stents from distal RCA
to posterior descending artery (PDA) crossing ostia of other three branches
with optional kissing balloon dilatation. An 8F JR4 guiding catheter was
engaged at the ostium of the RCA. A 0.014 inch Floppy guide wire and a Choice
PT wire were placed into the posterolateral (PL) branch and the PDA, respectively
(Figure
3). After predilation with a Stormer balloon (2.5 x 20 mm), two Cypher
stents (3.5 x 23 mm at 14 atm to 3.64 mm and 2.75 x 28 mm at 14 atm to 2.86mm)
were deployed consecutively at PDA and distal RCA (Figure
4, Figure
5). Then, a choice PT wire was re-introduced into the PL branch through
the stent strut for kissing balloon inflation. A Stormer balloon (2.5 x
20 mm) and a maverick balloon (2.5 x 20 mm) was placed at the PDA and PL
branch. Then, final kissing balloon inflation was performed (Figure
6 , Figure
7 , Figure
8 ). Although there was a significant compromise of the other branch,
no more procedure was done because the branch vessel looked not so big to
be treated. The final angiogram revealed optimal stent expansions without
significant residual narrowing in both treated branches (Figure
9, Figure
10). |
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