Treating with Stents for Tight Stenosis of LM Bifurcation Lesion

- Operator : Masakiyo Nobuyoshi

Treating with Stents for Tight Stenosis of LM Bifurcation Lesion

- Operator: Masakiyo Nobuyoshi, MD

Relevant Clinical History and Physical Exam

A 69-year-old man was admitted with efforting chest pain for one month. His risk factor was hypertension and he is ex-smoker. His current medications were anti-angina medication, antihypertensive medications and lipid lowering agents.

Relevant Test Results Prior to Catheterization

The EKG is normal. The cardiac biomarkers are normal. The echocardiography showed akinesia of LV apex and anteroseptum with preserved LV systolic function(EF=54%).

Relevant Angiography Findings

The left coronary angiography showed tight stenosis of LM bifurcation with LCX ostium (1, 1, 1) (Figure 1). The right coronary angiogram showed diffuse long lesion of intermediate severity.

Procedure

Doctor Nobuyoshi punctured the right femoral artery with an 8 Fr sheath. Left coronary ostium was engaged with an 8F JL catheter with 4.0 cm curve. 0.014 inch BMW wire were inserted into the LAD. Wire passage into the LCX was difficult. So, Fielder 0.014 inch wire was inserted at LCX by using FINECROSS microcatheter. He performed intravascular ultrasound (IVUS) evaluation for LAD and LCX ostium. It showed that the significant stenosis was located at the distal LMCA with cross sectional area of 2.1 mm2 and LCX ostium was tight stenosis( Movie 1). However, proximal LCX was small vessel and quiet normal. Doctor Nobuyoshi decided to perform the simple stenting at LMCA to pLAD crossing LCX ostium. Predilation was done using Ryujin 2.5 X 15 mm at LCX( Movie 2) and DuraStar 3.5 X 15 mm balloon at LMCA to pLAD. 3.5 X 23 mm XIENCE stent was deployed at LMCA to pLAD using simple cross over stent ( Movie 3). After stenting, additional high pressure balloon dilatation with DuraStar 3.5 X 15 mm balloon at 28atm. The final angiogram showed excellent result (Figure 2, Figure 3)