Bifurcation Lesion

- Operator : Maurice Buchbinder

Bifurcation Lesion
- Operators: Maurice Buchbinder, MD, Junghan Yoon, MD
Clinical Information

- Relevant clinical history and physical exam:
A 54-year-old man was admitted with effort chest pain for 3 years. Three months ago, chest pain got more frequent. ECG showed non-specific finding, and biomarker was within normal range.

- Relevant test results prior to catheterization:
Echocardiography showed normal LV systolic function without regional wall motion abnormality.
Thallium spect showed reversible large sized perfusion defect in LAD territory

- Relevant angiography findings:
Coronary angiogram showed a significant stenosis at LAD and diagonal bifurcation site.(Figure 1)

Interventional Management

- Procedural step:
An 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with an 8Fr JL guiding catheter with 3.5cm curve. A 0.014 inch BMW wire was inserted into the LAD, a 0.014 inch BMW wire was inserted into the LCX and a 0.014 inch Fielder wire was inserted into the diagonal branch. Proximal LAD and diagonal branch were predilated with 3.0X20mm, 2.5X15mm Maverick balloon respectively. The LAD bifurcation was treated by a mini-crushing technique. While keeping a 3.0 mm balloon at pLAD (Figure 2), we deployed Promus 2.5X15 mm stent at the diagonal ostium. After removal of stent balloon, the diagonal stent was crushed by a pLAD balloon. Then, we deployed Promus 3.0 X 28 mm at pLAD. (Figure 3) After rewiring of the diagonal artery, kissing balloon technique was done with Quantum 3.0 X 15mm, Maverick 2.0 X 15mm at pLAD and Diagonal branch respectively. (Figure 4) IVUS showed dissection at pLAD stent distal site. (Figure 5) We performed bailout stenting with Promus 2.5 X 18mm.(Figure 6) Final left angiogram showed that the procedure was successful.(Figure 7)

Comments

  • Dobrin Vassilev 2009-05-03 This is quite an interesting case. First - stent was implanted in quite healthy diagonal, which has only ostial (may be, not visible from the projection) lesion. Next - stent 3.0 mm diameter implanted in proximal LAD - very intersting choice of stent size for this region. Third - kissing ballooning with 2.0 balloon in diagonal - you can better not doing kiss at all - I can garantee that the result will be the same.
  • zhang yong 2009-05-10 not good

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