Left Main Disease with Diffuse RCA Lesion

- Operator : Seung-Jung Park

Left Main Disease with Diffuse RCA Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 61 year-old woman was admitted for several months of effort angina. Her coronary risk factor was hypertension. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=69%) without regional wall motion abnormality.
Baseline Coronary Angiogram
  1. The left coronary angiography showed discrete 50% stenosis of distal LM, severe stenosis of LAD ostium to proximal LAD and diffuse, tandem stenosis of proximal LCX ( Movie 1, Movie 2).
  2. The right coronary artery was anomalous origin and angiogram showed significant luminal narrowing at proximal to middle RCA ( Movie 3).
Procedure
We decided to perform intervention at left main lesion firstly, and then treat RCA lesion. A 7 Fr sheath was inserted through right femoral artery, and the left coronary artery was engaged with a 8 Fr JL4 SH guiding catheter. For LM bifurcation lesion, as FFR revealed 0.61 at pLAD and 0.63 at pLCx, we decided to do mini-crush. 0.014-inch 180cm Sion BLUE and Sion guidewire was inserted into the LCX and LAD, respectively. We pre-dilated LM to pLAD and pLCx using 2.5 x 20 mm BH PLUS (Figure 1, Figure 2). An Osiro stent 3.5 x 22 mm was successfully deployed at proximal LCX (Figure 3), firstly and then another Osiro stent 4.0 x 18 mm was deployed at LM to proximal LAD (Figure 4). Additional kissing ballooning was performed by using an Empira NC 3.5 x 15 mm at LM-pLAD and Pantera 3.0 x 15 mm at proximal LCX (Figure 5). We check angiogram and IVUS showed that the procedure was successful. ( Movie 4, Movie 5) And then, we moved on the RCA lesion. 7 Fr AL1 4.0 SH guiding catheter was engaged on RCA. Firstly, the lesion was dilated with BH PLUS 2.5 x 20 mm balloon (Figure 6). Two Osiro stents 3.5 x 40 mm and 3.5 x 13 mm was implanted sequentially (Figure 7). Final angiogram showed that the procedure was successful ( Movie 6, Movie 7).

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