Slides
Left Main Shaft Disease with concomitant LAD disease treated with LAD stenting under guidance of Fractional Flow Reserve after Simple Cross-Over Technique for Left Main Lesion
- Operator : Seung-Jung Park
| Left Main Shaft Disease with concomitant LAD disease treated with LAD stenting under guidance of Fractional Flow Reserve after Simple Cross-Over Technique for Left Main Lesion |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 67 year-old man was admitted with effort chest pain for the past 1 year. He received permanent pacemaker insertion for sinus node dysfunction about 8 years ago. His coronary risk factors were hypertension, diabetes mellitus, and hypercholesterolemia. The physical examination was unremarkable. The ECG showed ventricular pacing rhythm and cardiac markers were unremarkable. The echocardiography showed global hypokinesia with decreased EF (47%). Thalium SPECT showed reversible large sized defect in LAD territory. |
| Baseline Coronary Angiography |
The left coronary angiogram showed tight stenosis in LM shaft and significant lesion in mid LAD ( Movie 1, Movie 2). The right coronary angiogram showed near normal coronary artery ( Movie 3). |
| Procedure |
| An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8 Fr JL 4.0 catheter with side hole. A 0.014 inch BMW 190cm wire and a 0.014 inch Sion 180cm wire were inserted into the LAD and LCX, respectively. We examined lesions with IVUS to make a decision. IVUS examination revealed relatively normal LCX ostium (Figure 1). So, we intended to treat the lesions with simple cross-over technique for LM lesion. Predilatation was performed with a 2.5 x 20mm Blackhawk balloon at LM to pLAD (Figure 2). After predilatation, Resolute Integrity stent (3.5x26mm) was deployed at LM to pLAD (Figure 3). And then, postdilatation using a 4.0 x 15mm Empira NC balloon was performed (Figure 4). The following angiogram showed well-expanded stents. We checked FFR for mLAD lesion, which was 0.69. Therefore, we decided to treat mid LAD lesion. First, predilatation was performed with a 2.0 x 15mm Maverick balloon (Figure 5). Then, Resolute Integrity stent (2.5 x 18mm) was deployed at mid LAD (Figure 6). And then, postdilatation using the stent balloon (2.5 x 15mm) was performed. Final angiogram showed that the procedure was successful ( Movie 4, Movie 5). |
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