Diffuse Long LAD disease Treated with Three Drug-Eluting Stents Implantation

- Operator : Eberhard Grube

Diffuse Long LAD disease Treated with Three Drug-Eluting Stents Implantation

- Operator: Eberhard Grube, MD

Case Presentation

A 73-year-old woman was admitted with efforting chest pain. Her risk factor was hypertension. The EKG is normal and echocardiography showed normal left ventricular function (EF=63%) without regional wall motion abnormality.

Baseline Coronary Angiography

The left coronary angiography showed diffuse 70% stenosis of mid to distal LAD, tubular 80% stenosis of diagonal, and tubular 80% stenosis of distal LCX. ( Movie 1, Movie 2, Movie 3)

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, Soft, and BMW wire were inserted into the LCX, Di, and LAD, respectively. Distal LCX was predilated with 2.5 X 15mm Voyager TREK balloon. (Figure 1) The Biomatrix stent 3.0 X 18mm stent was deployed at dLCX. (Figure 2) And then, Di was predilated with 2.5 X 15mm Voyager TREK balloon. (Figure 3) The Biomatrix stent 3.0 X 18mm stent was deployed at Di. (Figure 4) Distal LAD lesion was predilated with 2.5 X 15mm Voyager TREK balloon. The Biomatrix stent 2.5 X 24mm stent was deployed at dLAD. (Figure 5) To determine the functional status of mid LAD lesion, we examined FFR. FFR showed 0.89 before adenosine infusion and 0.76 after adenosine infusion. So, we planned to insert stents at mid LAD. The Biomatrix stent 3.0 X 14mm stent and Xience Prime stent 3.0 X 33mm stent were deployed at mid LAD. (Figure 6, Figure 7) Final left angiogram showed that the procedure was successful. ( Movie 4, Movie 5, Movie 6)