Hybrid BRS + DES Stenting

- Operator : Seung-Jung Park

Hybrid BRS + DES Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 56 years old male patient was hospitalized for chest discomfort. He had history of myocardial infarction with percutaneous coronary intervention 2 months ago. His coronary arterial disease risk factor was hypertension and dyslipidemia. Her physical exam was normal. The electrocardiogram and cardiac enzymes were unremarkable. Echocardiography revealed focal hypokinesia of left ventricular mid-lateral wall with normal left ventricular systolic function.
Baseline Coronary Angiogram
  1. Left and coronary angiogram showed total occlusion at proximal left anterior descending (LAD) ( Movie 1) with collateral flow from left circumflex (LCX) ( Movie 2). Previously implanted stent at LCX was patent ( Movie 3, Figure 1)
  2. The right coronary angiogram showed mild stenosis through proximal to mid RCA ( Movie 4) with collateral flow to LAD ( Movie 5).
Procedure
7 Fr sheaths were inserted thorough the right femoral artery. Left coronary artery was engaged with a 7 Fr XB guiding catheter. The wire, 0.014-inch Fielder XT was inserted into the LAD under backup of Corsair 2.6Fr micro guide catheter. Pre-dilation for LAD was performed with a BH PLUS 2.5 x 20 mm balloon ( Movie 6) and Pantera LEO 3.0 x 20 mm balloon ( Movie 7). Pre-dilation for diagonal branch was performed with a BH PLUS 2.5 x 20 mm balloon ( Movie 8). And then XIENCE Alpine 2.5 x 15mm was implanted at diagonal branch ( Movie 9). After stenting for diagonal branch, kissing balloon with Pantera LEO 3.0 x 20mm for LAD and Emergy NC 2.75 x 15mm for diagonal branch was done ( Movie 10). And then Absorb GT1 BVS 3.0 x 28mm, 3.5 x 28mm was deployed at proximal to mid LAD ( Movie 11, Movie 12). Additional XIENCE Alpine 4.0 x 12mm DES was implanted at proximal LAD ( Movie 13). After stenting, we performed post-dilatation with Pantera LEO 3.0 x 20mm ( Movie 14) and Nimbus Salvo 3.5 x 17mm ( Movie 15) balloon. In conclusion, two DES were implanted into side branch and ostial lesion and two DES were implanted into LAD shaft lesion. Final angiogram ( Movie 16, Figure 2) and IVUS ( Movie 17) showed that the hybrid procedure was successful.

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