Left Main Trifurcation Lesion Treated with Single Stent Cross-Over Technique and Final Kissing Balloon Inflation
- Operator: Antonio Colombo, MD
Clinical presentation
A 57-year old woman was admitted due to effort chest pain for 6 months. Her coronary risk factor was diabetes and hypertension. His baseline ECG was normal. Echocardiography normal LV systolic function (EF = 56%).
Baseline coronary angiogram
1. Left coronary angiogram showed distal LM bifurcation stenosis and significant narrowing of ostium of LAD (Figure
1, Figure 2).
2. Right coronary angiogram was normal
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 8F XB catheter with 3.5 cm curve. Two 0.014 inch BMW guidewires were inserted into the LAD and LCX respectively. A 0.14 inch Rinato guidewire was inserted into the RI branch (Figure 3). A 3.5 X 23mm Cypher stent was positioned from the distal LM to the proximal LAD and deployed by 20 atm (3.83 mm) (Figure 4). And then, a 2.5 X 12 mm Quantum balloon was positioned at RI branch and deployed by 12 atm (2.5 mm) and a 3.5 X 12 mm Quantum balloon was placed at proximal LCX and deployed by 12 atm (2.5 mm). Final kissing balloon dilatation was done with a 3.0 X 12 mm Quantum balloon at LCX by 12 atm (3.0 mm) and a 2.5 X 12 mm Quantum balloon at RI by 12 (2.5 mm), and a Quantum 4.0 X 12 mm at LAD by 20 atm (4.19 mm) (Figure 5). Final angiogram showed a well-expanded stents without residual narrowing (Figure 6, Figure 7).
