Case

Successful Drug Eluting Stent Implantation in Left Main Coronary Artery Disease with Anomalous Origin

- Operator : Keyur H. Parkkh

Successful Drug Eluting Stent Implantation in Left Main Coronary Artery Disease with Anomalous Origin

- Operator: Keyur H. Parkkh, MD

Clinical Presentation

A 78 years old female was admitted with effort and accelerating chest pain for 15 days. Her coronary risk factor was hypertension. Baseline electrocardiogram showed a sinus rhythm with incomplete LBBB and echocardiography showed normal left ventricular function without regional wall motion abnormalities.

Baseline Coronary Angiogram

1. Right coronary angiogram showed normal findings.
2. Left coronary angiogram revealed anomalous origin of left main coronary artery (LMCA) from right cusp near right coronary origin and there was tubular 90% narrowing in distal segment of elongated LMCA (Figure 1, Figure 2).

Procedure

An 8F sheath was inserted through the right femoral artery and left coronary artery was engaged with 7F JR 3.5 Launcher guiding catheter. Fusion PTCA 0.014 inch wire was inserted across the lesion and predilation was performed with a Sprinter balloon (2.5mm X 20mm up to 10atm) (Figure 3, Figure 4). After predilation, Endeavor stent (3.5mm X 18mm up to 18atm) was implanted (Figure 5). Final angiogram showed a good result without residual narrowing and dissection with TIMI III flow (Figure 6).
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Comments

  • Rajagopal Jambunathan 2006-05-28 Nice to see such a rare case. I could not understand why a 20 mm balloon was initially used though the lesion is about 14mm and a 18mm stent was finally implanted.
  • Vijay Kapadia 2006-05-28 Had a patient in his 60s recently who had had an episode of near syncope and alate positive stress test at high workload on ECG criteria but without symptoms. He also had an anomalous LCA arising from the Right coronary sinus as in your case. We felt that he had compression of the LCA between the Pulmonary artery and the aorta. Did you have any such concerns? Vijay Kapadia vijaykapadia@hotmail.com
  • mganesh 2006-06-15 good work Sir & a interesting case too. did u give a trial of I/C NTG after the initial angio shoot. the lesion looks similar to what a spasm will look, except that its at a distance.but what makes my suspicion stronger is the fact that rest of his coronaries are fantastic and very clean.i had a case of mid- distal RCA spasm mimicking 90% block. he was taken up for ADHOC PTCA ( direct stenting). i gave a I/C NTG to help me choose the size of the stent( 3.0/3.5 mm).to my surprise the lesion disappeared in the next shoot. i have now made a practise of giving I/C NTG , if i see these smooth eccentic lesions when rest of the vessels are clean. In the following weeks i encountered similar lesion again, in mid RCA... preventing inadvertent stenting. THIS IS TO EMPHASIZE THAT SPASMS DO OCCUR DISTANT TO THE CATHETER TIP, SOMETIMES REALLY FAR OFF.dr. Ganesh Mathan.

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