Left Main Ostial and Shaft Lesion Treated with Cross-Over Technique Using Single Sirolimus-Eluting Stent

- Operator : Alan C. Yeung

Left Main Ostial and Shaft Lesion Treated with Cross-Over Technique Using Single Sirolimus-Eluting Stent

- Operator: Alan C. Yeung, MD, Teguh Santoso, MD,

Clinical Presentation

A 35-year old woman was admitted due to effort chest pain for 1 month. She had no risk factors. Baseline ECG showed T wave inversion in V3-6 and left ventricular systolic function was normal.

Baseline Coronary Angiogram

1. Left coronary angiogram showed a significant left main coronary artery (LMCA) ostium and shaft narrowing (Figure 1, Figure 2).
2. Right coronary angiogram was normal.

Procedure

A 7F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 7F JL catheter with 3.5 cm curve. Two 0.014 inch BMW wires were inserted into the left anterior descending artery (LAD) and left circumflex artery (LCX), respectively (Figure 3, Figure 4). Intravascular ultrasound (IVUS) examination showed severe atheromatous plaque burden from ostium to shaft of LMCA without negative remodeling (Figure 5) and mild plaque burden at the ostial LCX (Figure 6). Therefore, a 3.5 X 13 mm Cypher stent was positioned at the LMCA ostium extending to the LAD ostium and deployed by 14 atm (3.67 mm), crossing the LCX (Figure 7). Post-stent IVUS revealed good results without malapposition of the stent (Figure 8). Final angiogram showed a well-expanded stents without residual narrowing (Figure 9, Figure 10, Figure 11).
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