Slides
Simultaneous Bifurcation Stenting with V-stenting Technique for Distal Left Main and with Crush Technique for Left Anterior Descending Artery Lesion
- Operator : Seung-Jung Park
Simultaneous Bifurcation Stenting
with V-stenting Technique for Distal Left Main and with Crush Technique
for Left Anterior Descending Artery Lesion |
| - Operator: Seung-Jung Park, MD, Seung-Jae Tahk, MD, |
Clinical Presentation |
A 53 year old man was admitted with effort-related chest pain for 5 months. His coronary risk factors were diabetes and smoking. Baseline ECG finding was normal. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function (LVEF=60%). |
Baseline Coronary Angiogram |
1. Left coronary angiogram showed significant
narrowing at distal left main coronary artery (LMCA) bifurcation (Figure
1, Figure
2) and middle left anterior descending artery (LAD) bifurcation (Figure
3, Figure
4). |
Procedure |
| A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr JL guiding catheter with 3.5cm curve. Two 0.014 inch BMW wires were inserted into the LAD and the left circumflex artery (LCX) and third wire was inserted sequentially into the diagonal branch using a 0.014 inch Choice PT wire (Figure 5). At first, pre-dilation was performed at diagonal branch with 2.5 X 15mm Fighter (upto 6 atm, 2.50mm) and middle LAD with 2.5 X 15mm Fighter (upto 8 atm, 2.68mm) (Figure 6, Figure 7). After then, a 2.75 X 18mm Cypher stent was positioned at the diagonal branch and then, protruding struts of the side branch stent were crushed against the main LAD vessel wall with a 3.00 X 28mm Cypher stent upto 16 atm (3.21mm) (Figure 8, Figure 9). Additional 'kissing balloon post-dilation' was performed at LAD and diagonal branch with 3.0 X 20mm Ryujin (upto 8 atm, 3.00mm) and 2.5 X 20mm Maverick (upto 8 atm, 2.58mm) respectively (Figure 10). For the distal LM bifurcation lesion, 'V-stenting technique' was performed; a 3.5 X 13mm Cypher stent was inserted in distal LMCA to LAD followed by implantation of a 3.0 X 18mm Cypher stent across LCX (Figure 11, Figure 12). Then, a final kissing balloon dilation was performed with a 3.5 X 13mm stent balloon (8 atm, 3.00mm) in the LAD and 3.0 X 19mm stent balloon (8 atm, 2.88mm) in LCX (Figure 13). Final left angiogram showed good results without residual narrowing or dissection (Figure 14, Figure 15). |
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