We decided to treat mid RCA subtotal occlusion lesion by optimal medical therapy and to perform intervention at left main to LAD ostium. An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 7 Fr JL 5.0 catheter with side hole. Firstly, we advanced to LM shaft and LAD ostium with Sion 0.014-inch guidewire and implanted Orsiro stent 4.0 x 22, directly (Figure 1). Thereafter, post-stenting adjunctive balloon dilatation was done by Quantum 4.5 x 15 mm (Figure 2). After stenting, LCX ostium seemed to be narrowed ( Movie 5, Movie 6). IVUS was unable to pass the LCx ositum, so we checked FFR in order to determine additional whether or not to treatment the narrowed LCX ostium (Figure 3). FFR was measured from baseline 0.94 to 0.77 on 140mcg/kg/min of adenosine infusion. We advanced Sion 0.014-inch guidewire into the proximal LCX, followed by additional balloon dilatation with Lacrosse 2.5 x 15 mm at proximal LCX (Figure 4). After balloon angioplasty, FFR checked from baseline 0.98 to 0.94. On LAD pull-back IVUS images, there was no deformed or protruded strut at LCx opening, we did not perform kissing balloon. Final angiogram showed that the procedure was successful ( Movie 7, Movie 8).
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