Case

LM Stenting

- Operator : Seung-Jung Park

LM Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 71 year-old male patient was admitted for effort chest pain. His coronary risk factor was dyslipidemia. The physical exam was unremarkable, electrocardiogram (ECG) was normal sinus rhythm without ST or T changes. The echocardiography showed akinesia of posterolateral wall with ejection fraction of 51%.
Baseline Coronary Angiogram
  1. The left coronary angiogram & IVUS showed diffuse calcification from the proximal to middle LAD and LCX ( Movie 1). Severe eccentric stenosis at the LCX ostium and Di ostium was remarkably identified.
  2. The right coronary angiogram was normal.
Procedure
A 8Fr sheath was inserted thorough right femoral artery and, left coronary artery was engaged with a 7 Fr JL 4 guiding catheter. A 0.014-inch BMW 190 cm wire was inserted into LAD, LCX and Diagonal branch. Pre-dilation performed with a Sapphire NC 2.5 x 15 mm balloon and Flextome Cutting balloon 3.5 x 10mm balloon ( Movie 2, Movie 3). A Xience stent 2.5 x 18 mm was successfully deployed at diagonal branch by the crush technique with a Sapphire NC 3.25 x 18 mm balloon ( Movie 4). A Xience stent 3.0 x 23 mm were also deployed at the LCX by the crush technique with a Raiden3 4.0 x 15 mm balloon. And then a Xience stent 3.5 x 38mm was deployed at the LM to mLAD ( Movie 5). Additional kissing ballooning was performed by using a Sapphire NC 3.25 x 18 mm and Raiden3 4.0 x 15 mm balloon at the pLAD and pLCX, respectively ( Movie 6). The final angiogram and IVUS showed a successful result. ( Movie 7)

Appendix
IVUS image of pre-procedure ( Movie 8, Movie 9) and final image ( Movie 10, Movie 11)

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