Middle LAD Crossroads Treated by Kissing Balloon and Stenting

- Operator : Seung-Jung Park

Middle LAD Crossroads Treated by Kissing Balloon and Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 61 year-old man was admitted with effort chest pain for 6 months. He has no coronary risk factor. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. As noninvasive test, the thallium spect showed large reversible defect in LAD territory. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality.
Baseline Coronary Angiogram
1. A left coronary angiogram showed significant tight narrowing of middle LAD crossroads and ( Movie 1, Movie 2).
2. A right coronary angiogram showed intermittent stenosis at RCA ostium ( Movie 3).FFR value is 0.92 during hyperemia.
Procedure
An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8 Fr XB 3.5 catheter with side hole. Firstly, the BMW 0.014-inch guidewire was inserted at distal LAD and Fielder FC 0.014-inch guidewire with Crudsade 0.014 inch was inserted at septal branch (Figure 1). We tried to insert in diagonal using Fielder FC with 0.014 inch Crusade, but cannot advance to diagonal and showed extravascular dye stain (Figure 2). Preferentially we predilated septal branch using Maverick 1.5 * 15mm and implanted Resolute Integrity stent 3.0 & 38 mm on middle LAD crossroad. We tried again to insert wire in diagonal branch using Fielder FC with 0.014 inch Crusade and we can advance wire to diagonal branch (Figure 3). So we dilated diagonal branch using Maverikc 1.5 * 15 mm and Ryujin 2.0 * 20 mm. Final kissing balloon dilation was performed with a Empira NC 3.0 * 20 mm in middlel LAD and a Ryujin 2.0 * 20 mm in diagonal branch. Eventually we finished the procedure. Final angiogram showed that the stent was successfully implanted and septal branch and diagonal branch were all patent. ( Movie 4, Movie 5).

Comments

  • ANAZI 2014-05-28 well done
  • Long Bui 2014-07-27 Excillent case! It's difficult to insert wire to diagonal and septal branch. The selection guidewire for this lesion is very important. A hydrophylic sliding wire is the good option.

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