LM Bifurcation Lesion Treated by TAP Technique

- Operator : Seung-Jung Park

LM Bifurcation Lesion Treated by TAP Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 58 year-old male was referred to our hospital for a second opinion. Chest pain developed since 4 month ago. He underwent coronary angiogram which revealed severe stenosis at distal left main (LM) with concomitant involvement of proximal LAD and LCX. His coronary risk factor was hypertension. His baseline ECG and cardiac markers were unremarkable.
Baseline Coronary Angiography
  1. The left coronary angiogram showed severe stenosis at LM bifurcation.( Movie 1, Movie 2)
  2. The right coronary angiogram showed normal RCA.(Figure 1)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL 4 catheter. The 0.014-inch 190cm BMW wire was inserted into the LAD and another BMW wire was inserted in to the LCX. After IVUS, LM to proximal LAD was pre-dilated with 2.5 X 15mm Tazuna balloon. A Xience Alpine 4.0 X 23 mm stent was successfully deployed at LM to proximal LAD.(Figure 2). A LCX was rewired with Choice PT 0.014 inch wire. After dilatation with 2.5 X 15mm Tazuna balloon, Xience Alpine 3.5 X 18 mm stent was implanted at proximal LCX (Figure 3). And then kissing ballooning was performed by using a 3.5 X 20 mm non-compliant (NC) TREK balloon at LM to proximal LAD and 3.5 X 18mm stent balloon at LM to proximal LCX.(Figure 4). Final left angiogram showed successful result.( Movie 3, Movie 4)

Comments

  • Jae Hong Park 2016-04-10 Hum...well.. I think this tech. was used for this case in the way of TAP technique. If there is wrong thinking from me, send me another message.
  • Seung-Jung Park 2016-04-11 You are right. This is definitely TAP technique !
  • Khondaker Atiqur Rahman 2016-05-10 Does the LM to LAD stent seem oversized in Final LAO Caudal view?
  • Seung-Jung Park 2016-05-10 Even in the era of DES, I still prefer The bigger , the Better.

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