Overlapped Stenting and Kissing Balloon of LM Bifurcation Lesion

- Operator : Duk-Woo Park

Overlapped Stenting and Kissing Balloon of LM Bifurcation Lesion
- Operator: Duk-Woo Park, MD
Case Presentation
A 78 year-old female was admitted for recurrent effort chest pain aggravated from 4 weeks ago. She had a history of hypertension and diabetes mellitus. She underwent percutaneous coronary intervention at pLAD for unstable angina 19 years ago. The physical examination and electrocardiogram were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed severe stenosis at distal LM, proximal LAD and distal LCX. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed mild stenosis at mid to distal RCA. ( Movie 3)
Procedure
An 8 Fr sheath was inserted through right femoral artery and left coronary artery was engaged with an 8 Fr JL 4 guiding catheter. 0.014-inch NEO`s(Sion) 180 cm wire was inserted into the LAD and 0.014-inch NEO`s(Sion) 180cm wire was inserted into the LCX. IVUS was done, showing LM bifurcation stenosis involving proximal LAD ( Movie 4) but relatively preserved LCX ostium. ( Movie 5) First pre-dilation was performed with an IKAZUCHI zero 2.5 x 15 mm balloon at the LM to pmLAD. We overlapped a Xience Alpine stent sized 3.0 x 38 mm into the pmLAD and a Xience alpine stent size 4.0 x 33 mm into the LM to pLAD. ( Movie 6) And additional kissing ballooning was performed by using Raiden 3 3.5 x 15 mm at the LM to pLAD and NC TREK 3.5 x 15 mm at pLCX ( Movie 7). Final angiogram ( Movie 8, Movie 9) and IVUS ( Movie 10) showed the successful result.

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