Slides
Mid LAD in-Stent Restenosis Bifurcation Disease
- Operator : Thierry Lefevre
| Mid LAD in-Stent Restenosis Bifurcation Disease |
| - Operators: Thierry Lefèvre, Duncan Hung Kwong Ho |
| Clinical presentation |
| A 49-years old man was suffered from effort-related chest pain for 2 month. About 6 years ago, he received PCI at mid LAD with SLK-view3.5 3.0 X 17 mm and at big OM with B-H RS 3.5 X 18 mm. So, he visited our hospital and got coronary angiography. His cardiovascular risk factors was diabetes. Baseline ECG showed normal sinus rhythm. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function. Thallium SPECT showed reversible perfusion defect in LAD territory. |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed total occlusion
of in-stent of mid LAD & disctere 70% narrowing of ostial diagonal
branch(Figure
1). |
| Procedure |
| A 7 Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 7 Fr EBU guiding catheter with 4.0cm curve. A 0.014 inch BMW wire was inserted into the LAD and a 0.014 inch BMW wire was inserted into the Diagonal branch (Figure 2). Initially, we planned pre-dilation with Maverick 2.5 X 15mm at mLAD and Diagonal branch sequentially (Figure 3, Figure 4). IVUS study was done about LAD. IVUS findings revealed heavy plaque burden with severe calcification in the ISR lesion of mLAD (Figure 5). So, we planned pre-dilation with 2.75 X 10mm cutting balloon at mid LAD & Diagonal branch (Figure 6). After pre-dilation, a 3.5 X 28mm PROMUS stent was deployed at the mid LAD ISR lesion (Figure 7, Figure 8). We performed additional 'kissing balloon post-dilation' with 3.5 X 15mm Maverick at mid LAD and 2.5 X 15mm Maverick at Diagonal branch (Figure 9). And then, IVUS study was performed. IVUS findings showed good stent position at mLAD and patent Diagonal ostium. Final left angiogram showed that the procedure was successful (Figure 10, Figure 11). |
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