Stenting and Kissing Balloon of LM Bifurcation Lesion

- Operator : Seung-Jung Park

Stenting and Kissing Balloon of LM Bifurcation Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 82 year-old male was admitted for effort related chest pain since 4 weeks ago. His coronary risk factors were hypertension and diabetes. Physical examination and chest radiograph were unremarkable. His electrocardiogram showed right bundle branch block with no definite abnormal findings in ST segment or T wave. 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 with diagonal stenosis, and proximal LCX os ( Movie 1, Movie 2).
  2. The right coronary angiogram showed moderate stenosis at proximal RCA ( Movie 3) with negative FFR (0.85).
Procedure
An 8 Fr long sheath was inserted through the right femoral artery and left coronary artery was engaged with an 8 Fr JL 3.5 guiding catheter. Two 0.014-inch BMW wires were inserted into the LAD and into the LCX, either. After pre-ballooning for the LAD with Sapphire NC 2.5 x 18 mm upto 18 atm (2.60) and for the LCX with Sapphire NC 2.5 x 18 mm upto 14 atm (2.53), Xience Sierra stent 3.5 x 15 mm was inserted at the pLCX crossing high OM branch ( Movie 4) and balloon crushing using Raiden 3 3.5 x 20 mm upto 20 atm (3.68) was performed. We deployed Xience Sierra 3.5 x 28 mm at LM to pLAD lesion ( Movie 5) and additional NC ballooning was performed by using Sapphire NC 4.0 x 18 mm at LM to pLAD and Raiden 3 3.5 x 20 mm at proximal to mid LAD. And then, kissing ballooning was performed by using Sapphire NC 4.0 x 18 mm at the LM-pLAD and Sapphire 3.5 x 15 mm at the pLCX ( Movie 6). Final angiograms showed successful results ( Movie 7, Movie 8).

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