Slides
Ostial LM Disease with pLAD and pLCX Lesions
- Operator : Antonio Colombo
| Ostial LM Disease with pLAD and pLCX Lesions |
| - Operator: Antonio Colombo |
| Clinical presentation |
| A 61-year old man was admitted to evaluate abnormal thallium findings. He had no symptom. He was performed CABG at 03.21.2003. His coronary risk factor was only smoking. Baseline ECG showed non-specific ST segment change. Echocardiography revealed akinesia of mid posterior wall & hypokinesia of mid to basal lateral wall with relatively preserved LVEF(51%). Thallium SPECT showed partial reversible perfusion defect at LAD and LCX territories. |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed 80% narrowing
of LM os, tubular 80-90% narrowing |
| Procedure |
| A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB catheter with 3.5cm curve. Two 0.014 inch BMW wires were inserted into the LAD and the LCX. Ostial LM lesion was predilated with 3.5X10mm cutting balloon and then Taxus liberte 4.0X8mm stent was deployed at ostial LM lesion (Figure 4, Figure 5). Another Taxus liberte 3.0X32mm stent was deployed at proximal to mid LAD after predilatation with Maverick 2.5 X 20 mm (Figure 6). and then IVUS study was done about LM to mLAD stenting site. IVUS findings revealed underexpanded ostial LM & pLAD stenting site (Figure 7). So poststent balloon dilatation with Quantum 4.0 X 8mm 3.0 X 12mm respectively was done (Figure 8, Figure 10). Another Cypher select 2.5 X 33mm stent was deployed at proximal to mid LCX after predilatation with Maverick 2.5 X 20 mm and then poststent balloon dilatation with Quantum 3.0 X 12mm was done (Figure 10). IVUS study was done about proximal to mid LCX & ostial LM stenting site. IVUS findings revealed good positioned & well expanded stent at ostial LM and LCX (Figure 11, Figure 12). Final left angiogram showed that the procedure was successful. |
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