Slides

LM Bifurcation Disease with Tight LAD and LCX Bifurcation Lesions Treated with Kissing Technique Using Sirolimus-Eluting Stent

- Operator : Patrick W. Serruys

LM Bifurcation Disease with Tight LAD and LCX Bifurcation Lesions Treated with Kissing Technique Using Sirolimus-Eluting Stent
- Operators: Patrick W.Serruys, Myeong-Ki Hong
Clinical presentation
A 68-year old man was admitted with new onset effort chest pain for 6 months. His coronary risk factor is hyperlipidemia. Baseline ECG was normal. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function.
Baseline coronary angiogram

1. Left coronary angiogram showed 50-60% narrowing of LM(Figure 1), discrete 60-70% narrowing of pLAD, discrete 40-50% narrowing of pLCX (Figure 2)
2. Right coronary angiogram showed discrete 20-30% narrowing of mRCA and tubular 30-40% narrowing of dRCA (Figure 3).
Procedure
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB guiding catheter with 3.5cm curve. Two 0.014 inch BMW wires were inserted into the LAD and the LCX (Figure 4). IVUS study was done about LM bifurcation, LCX, and LAD. IVUS findings revealed heavy plaque burden in the LM bifurcation, proximal LAD and proximal LCX lesions (Figure 5). Without pre-dilation, a 3.5 X 10mm Cypher stent was positioned at the LM-LAD (Figure 6). Post-dilatation was performed with 3.5 X 10 mm stent balloon (Figure 7). Pressure wire was inserted into the LCX, then fractional flow reserve was monitored. IVUS study was done about LM bifurcation, LCX, and LAD (Figure 8). High-pressure balloon dilation was performed at proximal stent with 4.5 X 8mm Quantum (by 12 atm, 4.50mm) (Figure 9). For ostial LCX lesion, balloon dilatation was performed with 1.5 X 20 mm Maverick (by 10 atm, 1.59 mm) and 2.5 X 15 mm Ryujin (by 10 atm, 2.63 mm) (Figure 10, Figure 11). Additional ‘kissing balloon post-dilation’ was performed at LAD and LCX with 3.5 X 15mm Sprinter (by 10 atm, 3.62mm) and 2.5 X 15mm Ryujin (by 6 atm, 2.50mm) respectively (Figure 12). Final left angiogram showed that the procedure was successful.
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Comments

  • Debabrata Dash 2008-05-09 Congrats for the nice result.Personally I feel that IVUS should have been done after kissing balloon to see ostium of circumflex.
  • Dean Jia 2008-06-23 I don't think the stent in LM-LAD is 3.5 X 10 mm, it is longer. Another question is to postdilate the 3.5mm stent with a 4.5mm ballon, is it reasonable to do it?
  • Jang-Whan Bae 2008-08-01 Please, show us angiograms after the LAD stent implantation and final kissing balloon angioplasty. Thanks.
  • zhang yong 2009-03-25 Final result?

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