Left Main Bifurcation Lesion. Is Simple Stenting Cross-over Enough?

- Operator : Seung-Jung Park

Left Main Bifurcation Lesion. Is Simple Stenting Cross-over Enough?

- Operator: Seung-Jung Park, MD, Seong-Wook Park, MD,

Clinical Presentation

A 65-year old man was admitted with resting chest pain for 15 days. His coronary risk factor was diabetes. Baseline ECG showed nonspecific ST-T changes in anterior leads. Echocardiography showed a hypokinesia of right coronary artery (RCA) territory and normal left ventricular systolic function (EF = 56%).

Baseline Coronary Angiogram

1. Left coronary angiogram showed a distal left main coronary artery (LMCA) bifurcation stenosis and diffuse narrowing at middle left anterior descending artery (LAD) (Figure 1, Figure 2, Figure 3).
2. Right coronary angiogram revealed a significant narrowing at middle RCA, which was already treated by Cypher 3.5x28 mm one month ago (Figure 4).

Procedure

A 7F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL 4 catheter. Two 0.014 inch Asahi Neo¡¯s soft wires were sequentially inserted into the LAD and left circumflex artery (LCX) (Figure 5, Figure 6). At first, one Cypher stent was deployed at the proximal to middle LAD [3.0x28 mm upto 3.15(14 atm)] (Figure 7). And then, predilation of distal LMCA to proximal LAD was achieved with a Sprinter 3.0x20 mm upto 16atm (3.36mm) (Figure 8). After predilation, a 3.5x23 mm Cypher stent was positioned at the LMCA ostium to proximal LAD and deployed upto 16 atm (3.72 mm) (Figure 9). Additional high-pressure balloon was performed with a 4.0x15 mm Sprinter upto 14 atm (4.26 mm) (Figure 10). Final angiogram showed well-expanded stents without compromise of LCX and residual narrowing (Figure 11, Figure 12).
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Comments

  • Tudor C. Poerner, MD 2006-07-07 Very good result as a consequence of a rational strategy: since LCX ostium seemed to be sound, no side branch occlusion or significant damage after main vessel stenting over the take-off of the side branch is expected.
  • chmait 2006-07-10 I THINK THAT THE LCX OSTIUM PRESENTE UN STENOSIS BETTER TO PERFORM FINAL KISSING BALLON
  • Phong Nguyen 2006-07-14 I would agree that a final kissing balloon of L main-LAD and LCx ostium would optimise any residual stenosis.
  • Jae Sik Jang 2006-08-10 We thought that final kissing is not required because LCX ostium has no significant narrowing. And final angiogram revealed well-expanded stents with no compromise of LCX.
  • Silvestri 2006-08-30

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