Left Main Shaft & Proximal LAD Disease Treated by Simple Cross-Over Stenting

- Operator : Seung-Jung Park

Left Main Shaft & Proximal LAD Disease Treated by Simple Cross-Over Stenting

- Operator: Seung-Jung Park, MD

Case Presentation

A 61 year-old gentleman was admitted with effort chest pain for three months. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=70%) without regional wall motion abnormality. The thallium spect showed partially reversible large sized perfusion defect at LAD and RCA territory. His coronary risk factor was ex-smoking.

Baseline Coronary Angiogram

A left coronary angiogram showed significant tight narrowing of LM shaft and proximal to middle LAD. Additionally, tight stenosis was observed at proximal LCX and OM branch ( Movie 1, Movie 2, Movie 3) A right coronary angiogram showed total occlusion at distal RCA ( Movie 4)

Procedure

We decided to treat distal RCA CTO lesion by optimal medical therapy and to perform intervention at left main to middle LAD. 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. Firstly, we advanced to LCX and LAD with Soft wire 0.014-inch guidewire and predilatation was performed with a 2.5 x 15mm Black Hawk balloon (Figure 1). Subsequently, Xience Xpedition 2.75 x 28 mm and Xience Xpedition 3.25 x 33 mm were implanted at left main to middle LAD (Figure 2, Figure 3) Post-stenting adjunctive balloon dilatation using Empira NC 3.5 x 20 mm (Figure 4). We check angiogram, which showed good maintance of patency at proximal LCX ( Movie 5). So we removed wire at LCX, followed by additional adjunctive balloon dilatation with Quantum 4.5 x 8 mm at left main to proximal LAD (Figure 5). Final angiogram showed that the procedure was successful ( Movie 6, Movie 7).