Coronary > Ostial
LAD and LCX ostial lesions with short LMCA treated by Kissing Stenting
- Operator : Yasutaka Yamauchi
|LAD and LCX ostial lesions with short LMCA treated by Kissing Stenting|
|- Operator: Yasutaka Yamauchi, MD|
|Relevant clinical history and physical exam|
A 65 year-old female was referred to our hospital because of unstable angina. She had received hemodialysis for 15 years because of DM nephropathy. Her coronary risk factors were diabetes, dyslipidemia, smoking, and hemodialysis.
|Relevant catheterization findings|
Coronary angiography showed short LMCA and severe stenosis of LAD and LCX ostium with severe calcification ( Movie 1, Movie 2). RCA angiogram showed no significant luminal narrowing ( Movie 3). We performed PCI for both LAD and LCX lesions because she rejected CABG.
Our strategy was kissing stenting for both LAD and CX lesions under IABP support because of short LMCA. 8F JL3.5 guide was chosen to prevent ostial injury. LAD was ablated using rotabar 1.25 and 1.5mm ( Movie 4, Movie 5). After gudewires were kept in both LAD and LCX, KBT was performed with Ryujin 2.5X15mm for LAD and Racross 2.5X15mm for LCX. Ryujin balloon was ruptured, and so, LAD was dilated with Racross balloon (Figure 1). Dissection was observed at distal seg6. Taxus 2.5X20mm was inserted to LAD enough to cover form LMCA to LAD dissection, and Taxus 2.75X16mm was placed form LMCA to LCX ( Movie 6). Both the proximal edges of stents was accurately positioned in LMCA ostium and both stents were simultaneously deployed. Max pressure was 22atm. Final angiogram showed good dilation of both LAD and LCXos ( Movie 7, Movie 8, Movie 9).