Imaging & Physiology > FFR
LM Bifurcation-LCX Crossover (FFR Evaluation)
- Operator : Seung-Jung Park
|LM Bifurcation-LCX Crossover (FFR Evaluation)|
|- Operator: Seung-Jung Park, MD|
| - Relevant clinical history and physical exam:
A 68-year old woman was admitted with effort chest pain for 1 week. She underwent stenting with 3.5 * 30 mm GFX in mid LAD and 3.5 * 18mm GFX in OM1 at ten years ago. And at seven years ago, she received 3.5 * 18 mm RS in pLCX due to stable angina. She had a past medical history of diabetes and hypertension. Chronic medication contained ASA, Ca channel blocker, beta blocker and statins.
- Relevant test results prior to catheterization:
The ECG showed no significant ST changes. The ejection fraction was 55% with akinesia of LV apex and posterolateral wall.
- Relevant catheterization findings:
|- Procedural step:
7 Fr Judkins 3.5 guiding catheter was engaged in the left coronary artery through the femoral approach. Predilation of dLM to LAD with 3.0 * 10mm cutting balloon was done (Figure 2). And then, 3.5 * 28mm Cypher stent was deployed at pLAD to LM across LCX without protection (Figure 3). After stenting, additional balloon dilation was done with 4.0 * 12 mm Quantum balloon(non-compliant balloon). At that time, angiogram showed LCX ostium was jailed (Figure 4a, Figure 4b). So, We checked FFR by intracoronary adenosine bolus infection. The values was 0.95/0.89 pre/post adenosine injection, respectively (Figure 5). According to FFR results, kissing balloon was performed with 3.5 * 20 mm Pleon balloon at pLAD to LM and 3.0 * 20mm Ryujin balloon at pLCX to LM (Figure 6). After kissing balloon, FFR was 1.0/0.97 pre/post adenosine injection, respectively (Figure 7). Final angiogram showed a well-expanded LM to pLAD stent without jail of LCX ostium (Figure 8a, Figure 8b).