Slides
Distal Left Main Trifurcation Lesion Treated Using Simple Cross-over Stent and Kissing Balloon Technique
- Operator : Seung-Jung Park
| Distal Left Main Trifurcation Lesion Treated Using Simple Cross-over Stent and Kissing Balloon Technique |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 76 year-old gentleman male was hospitalized with effort chest pain developed one month ago. His coronary risk factors were hypertension and dyslipidemia. The ECG and cardiac enzymes were unremarkable. The 2-dimensional transthoracic echocardiography showed normal LV systolic function (EF=62%) without RWMA. Exercise treadmill test was strong positive at a 1.7 mph and 0% grade of modified Bruce protocol. Thallium SPECT showed reversible large sized perfusion defects in LAD and LCX territories. Syntax score was 20. |
| Baseline Coronary Angiogram |
1. The left coronary angiogram showed significant stenosis at distal LM trifurcation lesion ( Movie 1, Movie 2).2. The right coronary angiogram showed tubular significant stenosis at PDA branch ( Movie 3). |
| Procedure |
| 9 and 8 Fr sheaths were inserted into left and right femoral artery, respectively. Firstly, we place prophylactic IABP in the descending aorta through left femoral artery and started with 2:1 pumping ( Movie 4). An 8 Fr JL 3.5 guiding catheter with side hole was engaged into left coronary artery ostium through right femoral artery. And then, we inserted a 0.014 inch Sion wire into LCX and ramus branch. After that, we tried to insert a 0.014 inch Sion wire into LAD, but failed. Thus, we inserted a 0.014 inch Fielder XT wire into LAD using FINECROSS microcatheter, and then we exchanged a Fielder XT wire for a BMW wire (300cm length) (Figure 1). Predilatation was performed at distal LM to proximal LAD with a Maverick balloon 2.5x15mm (Figure 2). After predilatation, we deployed a Resolute Integrity stent 4.0x22mm at LM to pLAD crossing over LCX (Figure 3). After deploying stent, a follow-up angiogram showed that ostia of LCX and ramus branch looked compromised. So we sequentially rewired LCX and ramus branch using a 0.014 inch Fielder FC wire and a 0.014 inch Sion wire. A balloon dilatation was performed with a Maverick balloon 2.5x15mm at pLCX and proximal ramus branch, respectively (Figure 4, Figure 5). After that, kissing balloon was performed at LM to proximal LAD with a Nimbus Salvo balloon 3.5x17mm and proximal LCX with a Maverick balloon 2.5x15mm (Figure 6). Finally, we decreased IABP pumping ratio to 8:1. Final angiogram showed that the procedure was successful ( Movie 5, Movie 6). |
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