Direct stenting for the left main ostial lesion

- Operator : Gregg W. Stone

Direct stenting for the left main ostial lesion
- Operator: Gregg W. Stone, MD
Case Presentation
A 76 year-old female was admitted with effort chest pain for about six months. Her coronary risk factor was hypertension. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. Cardiac stress perfusion CT showed severe stenosis of LM ostium and decreased perfusion at LAD territory. Thallium test and treadmill test were not done. Syntax score was 18.
Baseline coronary angiography
1. The left coronary angiogram showed discrete tight stenosis at left main ostium ( Movie 1, Movie 2, Movie 3)
2. The right coronary angiogram showed diffuse 50-60% stenosis at RCA ( Movie 4).
Procedure
An 8 Fr sheath was inserted through right femoral artery and the left coronary ostium was engaged with an 8Fr JL 4.0 catheter with side hole. Two 0.014 inch BMW wires were inserted into the LAD and LCX, respectively. And then, they performed intravascular ultrasound evaluation from LM to LAD. Without predilatation, they deployed a Xience-Prime stent 3.5 x 28mm at the LM ostium to proximal LAD (Figure 1). Thereafter, post-stenting adjunctive balloon dilatation was done using Dura Star 4.0 x 15mm and Quantum 4.5 x 12mm sequentially. Final angiogram showed well-expanded and well-positioned stent ( Movie 5, Movie 6).

Comments

  • Arash Gholoobi 2012-06-27 I beleive a 4 by 8 stent just at the LM ostium deployed at very high pressure could be enough.

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