IVUS guided LM Trifurcation Treatment Using Simple Cross-Over Technique

- Operator : Seung-Jung Park

IVUS guided LM Trifurcation Treatment Using Simple Cross-Over Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 69-year-old man was brought to the outpatients department, refer from another hospital for efforting chest pain. His risk factor was hypercholesterolemia. He is non-smoker. His current medications were antiplatelet medication, antihypertensive medications and lipid lowering agents. The EKG is normal. The cardiac biomarkers are normal. The echocardiography showed normal left ventricular function (EF=65%) without regional wall motion abnormality.
Baseline Coronary Angiography
The left coronary angiography showed tight stenosis of LM trifurcation. ( Movie 1, Movie 2)
The right coronary angiogram was normal.
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 3.5 cm curve. At first sight, the stenotic lesion at the distal LM was so tight and true trifurcation lesion. A 0.014-inch BMW 190cm, Soft wire 175cm and BMW 190cm were inserted into the LAD, RI, and LCX, respectively. After IVUS examination, we found some discrepancies between angiographic and IVUS finding. IVUS showed the significant stenosis at the distal LMCA with diffuse proximal LAD lesion. However, RI and LCX ostium appeared quiet normal. So, we planned to insert stents using simple cross-over technique. After predilatation using a Black hawk 2.5 x 16mm balloon, Promus element stent 3.5 x 24mm was deployed at distal LM to proximal LAD. (Figure 1, Figure 2) After post-dilatation using a Dura star 4.0 X 15mm balloon (Figure 3), IVUS was examined. There were no jailing of the RI and LCX ostium. Final angiogram showed a well-expanded stents without residual narrowing. ( Movie 3, Movie 4)

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