Successful simple cross over stenting crossing many side branches

- Operator : Seung-Jung Park

Successful simple cross over stenting crossing many side branches

- Operator: Seung-Jung Park, MD

Clinical presentation

This 73-year-old man was admitted due to the accelerating effort related chest pain since 3 months ago. His coronary artery risk factors were hypertension, smoking and hyperlipidemia. EKG showed non-specific findings and echocardiogram was normal findings. However, thallium SPECT showed large perfusion defect at LAD territory. Therefore, coronary angiogram was performed and showed diffuse stenosis from LM to mLAD ( Movie 1, Movie 2). Although attending physician strongly recommended the bypass surgery due to good distal run-off of LAD, LM disease and, more importantly, the concern about the side branch jail, he refused to have surgery.

Procedure

A 8Fr JL4 guiding catheter was engaged into LMCA. After acquisition of LM to LAD angiogram, we decided to treat the lesion by simple cross over stenting with jailed wire technique because the ostiums of side branches had minimal stenosis. A 0.014 inch BMS wires were inserted into the LAD and LCx, and a 0.014 inch Soft wire was inserted into the diagonal branch (Figure 1). We sequentially performed balloon dilatation from mLAD to dLM using Black Hawk 2.5X20mm (Figure 2). Thereafter, Promus Element (2.0X24mm) stent was implanted at mLAD (Figure 3). A 0.014 inch BMS wires were inserted into the diagonal branch and Promus Element (3.5X28) stent was implanted at LM to mLAD (Figure 4). And using Dura Star 3.5X20mm, post adjunctive balloon dilatation was done (Figure 5) Final angiogram showed successful results without any compromising side branches ( Movie 3, Movie 4)