LM Bifurcation Treatment with Simple Cross-Over Technique

- Operator : Huay Cheem Tan

LM Bifurcation Treatment with Simple Cross-Over Technique

- Operator: Huay Cheem Tan, MD

Case Presentation

A 67-year-old man was admitted with efforting chest pain. His risk factor was hypertension and diabetes mellitus. The EKG is normal and echocardiography showed normal left ventricular function (EF=62%) without regional wall motion abnormality. Treadmill test showed positive (ST depression at the recovery phase) and thallium test showed reversible large defect of LAD territory.

Baseline Coronary Angiography

The left coronary angiography showed severe stenosis of LM bifurcation. ( Movie 1, Movie 2) The right coronary angiogram was normal.

Procedure

A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr JL guiding catheter with 4cm curve. A 0.014 inch BMW and Runthrough NS wire were inserted into the LAD and the LCX, respectively. Distal LM to proximal LAD lesion were predilated with 2.0 X 15mm Ikazuchi balloon. (Figure 1) After IVUS examination, we found that ostium of LCX was patent. So, we planned to insert stents by simple cross-over technique. The Promus element stent 3.5 X 20mm stent was deployed at LM to pLAD. (Figure 2) Post-stent ballooning with Quantum 4.5 X 8mm was done. (Figure 3) And then, IVUS and FFR examination were done at LCX. There is no jailing of LCX ostium (IVUS showed lumen area of LCX ostium was 5.8mm2 and FFR showed 0.95 after adenosine infusion). Final left angiogram showed that the procedure was successful. ( Movie 3, Movie 4, Movie 5)