Procedural step:
LAD was engaged with 7F XB 3.75 guiding catheter. Although the exact entry
point of occluded LAD could not be defined definitely by angiogram, coronary
MDCT findings showed that occluded segment was just adjacent to big diagonal
bifurcation point. (Figure
9) At first, antegrade wiring was attempted with a 0.014 inch Runthrough
PTCA wire (Terumo, Japan) and it did not penetrate proximal cap. (Figure
10) Another 0.014 inch PTCA wire (Miracle 3, Terumo, Japan) was attempted,
but failed too. (Figure
11) After several attempts, 0.014 inch Miracle 6 PTCA wire (Terumo,
Japan) was advanced forward and began to penetrate toward the correct
direction. (Figure
12, Figure
13, Figure
14, Figure
15, Figure
16, Figure
17) Then, predilation of proximal to mid LAD was achieved with a Ryujin
1.25 × 15 mm balloon (Figure
18) by 8 atm (1.3 mm), a Ryujin 2.0 × 15 mm balloon (Figure
19) by 12 atm (2.17 mm), and a Ryujin 2.5 × 20 mm balloon (Figure
20) by 8 atm (2.58 mm) sequentially. After predilation, a 3.0 X 30
mm Endeavor stent (Figure
21) was positioned at proximal to mid LAD and deployed by 14 atm (3.18
mm) and a 3.0 × 24 mm Endeavor stent (Figure
22) at mid LAD by 14 atm (3.18 mm). Additional ballooning of proximal
stent was done with a 3.0 × 24 mm stent balloon (Figure
23) at 18 atm (3.34 mm). Final angiogram showed well-expanded stents
with no residual narrowing. (Figure
24, Figure
25) |
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