Slides

LM Bifurcation Disease with Tight LAD Stenosis Treated with Simple Cross over and Kissing Balloon

- Operator : Eulogio Garcia

LM Bifurcation Disease with Tight LAD Stenosis Treated with Simple Cross over and Kissing Balloon
- Operator: Eulogio Garcia
Clinical presentation
A 71-year old woman was suffered from effort chest pain for several months. So, she visited other hospital and got coronary angiography. That coronary angiogram showed left main coronary artery disease. So, she referred from that hospital for management of this lesion. She had a history of PCI at dLCX a few years ago. Her coronary risk factors were diabetes, hypertension. Baseline ECG showed normal sinus rhythm. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function.
Baseline coronary angiogram

1. Left coronary angiogram showed 90% narrowing of distal LM, 90% narrowing of LAD os , patent LCX os and previous stent at dLCX (Figure 1)
2. Right coronary angiogram showed normal coronary(Figure 2)
Procedure
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr EBU guiding catheter with 3.5cm curve. A 0.014 inch BMW wires was inserted into the LAD and a 0.014 inch NEO’s(soft) wire was inserted into the LCX (Figure 3). IVUS study was done about LM bifurcation, LAD. IVUS findings revealed heavy plaque burden in the LM bifurcation, proximal LAD and no plaque in the LCX os (Figure 4). Initially, we planned pre-dilation with 3.0 X 10mm cutting balloon at LM shaft to LAD os (Figure 3, Figure 5). After pre-dilation, a 3.5 X 23mm Xience stent stent was positioned at the LM os and pLAD(Figure 6). Angiogram after stent positioning showed jailing of LCX os(Figure 7). So we planned additional 'kissing balloon post-dilation' at LM-LADos and LM-LCX os. We performed kissing balloon with 3.5 X 20mm Quantum at LM-LADos and 3.0 X 12 mm at LM-LCX os respectively (Figure 8). And then, IVUS study was performed. IVUS findings showed good stent position at pLAD and patent LCX os(Figure 9). Final left angiogram showed that the procedure was successful (Figure 10).
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Comments

  • Hisham 2008-05-10 I think in a case like this, with a significant critical lesion involving left main with the osteal LAD, the surgical option [CABG] would be much better and advantegeous. Hisham Selim, MD
  • Alberto Hendler 2008-05-11 Add a comment is useless because there is no dialog with the operator or with the web site director.
  • Muhammad 2008-05-26 I think Hisham is correct.
  • ahmed rushdy 2008-06-07 I think it is a good dicision because there is a high surgical risk (look to the distal vessels)
  • Dean Jia 2008-06-23 I agree with Alberto Hendler, the website is good but there is little communication between operator and reader.
  • Young-Hak Kim 2008-09-22 CABG is surely the first line of therapy for such a case. However, with the cumulative experience of PCI, elective PCI for patients at a low clinical risk profile can lead to favorable procedural and long-term outcomes.
  • Tamzeed Ahmed 2008-10-03 I agree,good angiographic postprocedural result is obtained,considering the distal disease of the vessel. However periodic follow-up(preferable angiographic) is required to establish long term efficacy of PCI over surgery.

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