Topics Coronary Long Lesion
Diffuse tandem stenoses in LAD treated by step-by-step approach using FFR guidance
- Operator : Seung-Jung Park
|Diffuse tandem stenoses in LAD treated by step-by-step approach using FFR guidance|
|- Operator: Seung-Jung Park, MD|
A 51 year-old female presented with effort-related chest pain for 2 month. She suffered from exertional dyspnea for 3 years. She had a past medical history of hyperlipidemia and hypertention. Her resting ECG and echocardiogram were normal.
|Baseline coronary angiogram|
A left coronary angiogram showed severe stenosis in distal LCX. The LAD had two significant stenoses in proximal and mid segment, respectively. The latter one had a nearly right angle (Figure 1, Movie 1).
Left coronary artery was engaged with a 7Fr XB 3.5 guiding catheter with side holes. We placed a pressure wire in the distal LAD segment beyond the mid LAD stenosis. After adenosine infusion at 140mcg/kg/min to obtain maximum hyperemia, the FFR value in the distal LAD was 0.62 and then the pressure wire was slowly pulled back during adenosine infusion. The FFR value in-between those two diseased segments was 0.78 and the value in the proximal LAD prior to the 1st stenosis rose up to 0.99 (Figure 2). The pressure difference (กโ pressure) by FFR across the proximal stenosis was greater (0.21) than that of the distal stenosis (0.16). Thus, we treated the proximal lesion firstly with pre-ballooning (Elect 2.5 x 20 mm) and stenting (Xience V 3.5 x 28 mm) (Figure 3, Figure 4). After optimizing the stent using a non-compliant balloon (Dura Star 3.5 x 15 mm), the FFR value in distal LAD was rechecked. It was 0.56 with maximum hyperemia which had a hemodynamic significance ( Movie 2, Figure 5). The distal lesion was pre-dilated with the Elect 2.5 x 20 mm balloon and a Xience V 3.0 x 23 mm stent was placed with overlap (Figure 6, Figure 7). Adjunctive balloon dilatation was done with stent balloon (Figure 8). The final angiogram showed a good result with TIMI 3 flow ( Movie 3).