Slides Coronary

Overlapped Stenting and Kissing Balloon of LM Bifurcation Lesion

- Operator : Duk-Woo Park

Overlapped Stenting and Kissing Balloon of LM Bifurcation Lesion
- Operator: Duk-Woo Park, MD
Case Presentation
A 78 year-old female was admitted for recurrent effort chest pain aggravated from 4 weeks ago. She had a history of hypertension and diabetes mellitus. She underwent percutaneous coronary intervention at pLAD for unstable angina 19 years ago. The physical examination and electrocardiogram were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed severe stenosis at distal LM, proximal LAD and distal LCX. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed mild stenosis at mid to distal RCA. ( Movie 3)
Procedure
An 8 Fr sheath was inserted through right femoral artery and left coronary artery was engaged with an 8 Fr JL 4 guiding catheter. 0.014-inch NEO`s(Sion) 180 cm wire was inserted into the LAD and 0.014-inch NEO`s(Sion) 180cm wire was inserted into the LCX. IVUS was done, showing LM bifurcation stenosis involving proximal LAD ( Movie 4) but relatively preserved LCX ostium. ( Movie 5) First pre-dilation was performed with an IKAZUCHI zero 2.5 x 15 mm balloon at the LM to pmLAD. We overlapped a Xience Alpine stent sized 3.0 x 38 mm into the pmLAD and a Xience alpine stent size 4.0 x 33 mm into the LM to pLAD. ( Movie 6) And additional kissing ballooning was performed by using Raiden 3 3.5 x 15 mm at the LM to pLAD and NC TREK 3.5 x 15 mm at pLCX ( Movie 7). Final angiogram ( Movie 8, Movie 9) and IVUS ( Movie 10) showed the successful result.

Comments

  • Jae Hong Park 2018-07-21 Thanks you for your case sharing and introduction. At True bifurcation lesion, especially medina 1,1,1 characteristic lesion, you usually use sigle cross-over stenting and final kissing balloon and the data of F/U result was good? I'm really interesting about that. Are there any other cohort or prospective study about that? I hope to take the data about sigle cross-over stenting and final kissing balloon.
  • Osung Kwon 2018-07-23 Thank you for your interest and valuable comment. Actually, we demonstrated this case for emphasizing the importance of IVUS evaluation for LM bifurcation PCI. IVUS at LCX showed distinct stenosis at POC but LCX itself. Thus median was 1,1,0 according to the IVUS finding. Hence, although angiography showed that the bifurcation lesion might be involving the LCX ostium, we did simple cross-over based upon the IVUS finding. Fortunately, The simple crossover technique was working well without compromising the LCX. Thanks for your comment, we revised the manuscript as following; IVUS was done, showing LM bifurcation stenosis involving proximal LAD (movie 4) but relatively preserved LCX ostium. (movie 5)

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