Slides Coronary Long Lesion
Diffuse Long LAD Disease Treated with Two Drug-Eluting Stents Implantation
- Operator : Maurice Buchbinder
Diffuse Long LAD Disease Treated with Two Drug-Eluting Stents Implantation |
- Operator: Maurice Buchbinder, MD |
Clinical presentation |
A62-year-old woman was admitted due to effort chest pain for 4 months. His risk factor was diabetes. The electrocardiogram was normal and his left ventricular function was normal. |
Baseline coronary angiogram |
1. Left coronary angiogram showed diffuse narrowing of proximal to mid LAD and distal LCX (Figure
1, Figure 2). 2. 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 EBU catheter with 3.5 cm curve. A 0.014 inch BMW guidewire was inserted into the left anterior descending artery (LAD). Predilation of LAD was achieved with a 2.0 X 15 mm Maverick balloon 12 atm (2.2 mm) (Figure 3, Figure 4). IVUS examination showed significant plaque burden with heavy calcification at proximal to mid LAD. Therefore, a 3.0 X 10 mm cutting balloon was positioned at proximal LAD and deployed at 8 atm (3.0 mm) (Figure 5). After then, a 2.75 X 33 mm Cypher select stent was positioned at the mid to distal LAD and deployed by 16 atm (2.96 mm) and a 3.0 X 23 mm Cypher select stent was placed at the proximal LAD and deployed by 14 atm (3.15 mm) (Figure 6, Figure 7, Figure 8). Additional balloon was performed with a 3.5 X 12 mm Quantum balloon by 8 atm (3.33 mm) at mid to distal LAD and 14 atm (3.51 mm) at proximal LAD (Figure 9). Post-stent IVUS revealed malapposition of the proximal to mid LAD stent and additional ballooning at proximal segment of LAD stent was performed with a 3.5 X 11 mm Quantum balloon by 18 atm (3.62 mm). Final angiogram showed a well-expanded stents without residual narrowing (Figure 10, Figure 11). |
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