Case

Left Main Ostial and Shaft Lesion Treated with Cross-Over Technique Using Single Paclitaxel-Eluting Stent

- Operator : Alexandre Abizaid

Left Main Ostial and Shaft Lesion Treated with Cross-Over Technique Using Single Paclitaxel-Eluting Stent
- Operator: Alexander Abizaid, MD
Clinical presentation
A 47-year-old woman was admitted due to effort chest pain for 3 months. Her risk factor was hyperlipidemia. The electrocardiogram showed T wave inversion on I and aVL and the treadmill test was positive at stage III. Her left ventricular function was normal.
Baseline coronary angiogram
1. Left coronary angiogram showed diffuse narrowing from ostium to shaft of LMCA and tubular narrowing of mid LAD (Figure 1, Figure 2).
2. Right coronary angiogram was normal.
Procedure
An 8 sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 3.5 cm curve. Two 0.014 inch BMW wires were inserted into the left anterior descending artery (LAD) and left circumflex artery (LCX), respectively (Figure 3, Figure 4). IVUS examination showed non-significanct plaque burden at the ostial LCX and severe atheromatous plaque burden from ostium to shaft of LMCA without negative remodeling. Therefore, a 3.5 X 16 mm Taxus stent was positioned at the LMCA ostium extending to the proximal LAD and deployed by 8 atm (3.5 mm), crossing the LCX (Figure 5, Figure 6). Additional ballooning was performed with stent balloon upto 12 atm (3.68) (Figure 7). Post-stent IVUS revealed satisfactory result without malapposition of the stent. Final angiogram showed a well-expanded stents without residual narrowing (Figure 8, Figure 9).
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Comments

  • Sajan 2007-05-28 Excellent case.why was the wire in LCX removed prior to stent deployment. It could have served to cross the struts better had LCX ostium got pinched. It would be interesting to know the postprocedural IVUS assessment of LCX ostium.

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