Slides

Treatment of distal LM bifurcation stenosis after "V-stenting" technique

- Operator : Seung-Jung Park

Treatment of distal LM bifurcation stenosis after "V-stenting" technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 58 year old woman was admitted with effort chest pain for 2months. She received PCIs at pLAD in 1997, mLAD in 2005 then PCI at pLCx in 2007 due to NSTEMI. The actual result of several stenting looks like “V-stenting” technique. She had hypertension and gout for risk factors. Her echocardiography showed moderate left ventricular dysfunction (EF=43%) with akinesia of inferoposterolateral wall. Treadmill test was positive at stage 2 and thalium SPECT showed partially reversible large sized moderately decreased perfusion defect in LAD and LCX territories.
Baseline Coronary Angiography
The left coronary angiogram showed left dominant system, severe ISR of proximal LCX and LAD and distal LM involvement. Mid LAD stent was relatively patent ( Movie 1, Movie 2). The right coronary angiogram showed diminutive system and total occlusion of pRCA.
Procedure
An 8F sheath was inserted through right femoral artery and a 6F sheath at left femoral artery then started 1:2 IABP pumping. The left coronary ostium was engaged with an 8F XB 3.5 guiding catheter. A 0.014 inch BMW wire was inserted into the LAD and Shinobi 0.014 inch with FINECROSS 1.8F coronary micro-guide catheter into the LCX. We decided to use a stent for distal LM to proximal ISR lesion of LAD and a drug eluting balloon for pLCX ISR lesion. After predilation, 4.0 x 20mm PROMUS element stent was implanted at distal LM to proximal edge of previous stent at LAD with post dilation with 4.0 x 17mm Nimbus Salvo and 3.5 x 20mm Quantum balloon (Figure 1, Movie 3). The pLCX ISR was predilated with 2.0 x 20mm Maverick and 3.5 x 20mm Dura Star balloon (Figure 2). Then in-stent kissing balloon angioplasty was performed at LM bifurcation ( Movie 4). Finally, we used a 3.5 x 20mm SeQuent Please drug eluting balloon for LCX ISR lesion. Final angiogram showed a good result with well-expanded stent ( Movie 5, Movie 6).

Comments

  • M Tarek Mounir Zaki 2011-07-09 Absolutelly spectacular.My compliments for the technique & result!!!!
  • Seung-Jung Park 2011-07-10 Thank you for nice comment.
  • Joao Alexandre Farjalla 2011-07-12 Well done! Planning to repeat angiography?
  • Seung-Jung Park 2011-07-12 Routine repeat angiography will not be considered. MD coronary CT and/or Non-invasive stress test would be OK for follow-up of this patient.

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