Slides
Distal LM Bifurcation Lesion with Procedure Related Thrombi
- Operator : Seung-Jung Park
Distal LM Bifurcation Lesion with Procedure Related Thrombi |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 64-year-old woman presented with recently aggravated effort chest pain. Her coronary risk factor was hypertension. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=64%) without RWMA. Thallium SPECT showed reversible large sized perfusion defects in LAD and LCX territories. |
Baseline Coronary Angiography |
1. The left coronary angiogram showed severe stenosis at distal LM bifurcation and proximal to mid LAD ( Movie 1, Movie 2). 2. The right coronary artery was normal ( Movie 3). |
Procedure |
Five and Eight Fr sheaths were inserted into left and right femoral arteries, respectively. An 8 Fr JL 4 guiding catheter with side hole was engaged into left coronary artery ostium through right femoral artery. A 0.014 inch BMW wire was inserted into LAD. Initially, we checked IVUS at LM to mid LAD (LM-mLAD). Predilatation was performed at mid LAD with an Ikazuchi 2.0x20 mm balloon (Figure 1). After predilatation, following angiogram showed thrombi at mid LAD with TIMI grade I flow ( Movie 4). We injected abciximab into intracoronary and checked an activated clotting time (ACT). ACT value was 357 seconds. A Resolute intergrity stent 3.0x38mm at proximal to mid LAD was deployed (Figure 2, Movie 5). And then, we inserted a 0.014 inch BMW wire into LCX and deployed a Resolute Integrity stent 3.0 x 18 mm at LM to proximal LCX (Figure 3). Crushing was done with an Empira NC balloon 4.0x15mm at LM to pLAD (Figure 4). We deployed a Resolute integrity stent 4.0 x 26mm at LM to pLAD with overlapping (Figure 5). Additional balloon dilatation was done using Empira NC balloon 4.0x15mm at LM-pLAD. A 0.014 inch Fielder FC wire was inserted into LCX. Thereafter, additional balloon dilatations were done using Maverick 1.5x15mm and Ikazuchi 2.5x20mm at LM-pLCX, and an Empira NC 4.0x15mm at LM-pLAD. Final kissing balloon dilation was performed with an Empira NC 4.0x15mm at LM-pLAD and a Nimbus Salvo 3.0x17mm at LM-pLCX (Figure 6). Final angiogram showed well-expanded and well-positioned stents ( Movie 6). |
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