PCI in a Patient with Anomalous Origin of LMCA Arising from RCA

- Operator : Jung-Min Ahn

PCI in a Patient with Anomalous Origin of LMCA Arising from RCA
- Operator: Jung-Min Ahn, MD
Case Presentation
A 59-year-old male patient was admitted for resting and ongoing chest pain started from 2 hours ago. He had a history of hyperlipidemia and was an ex-smoker. The physical exam was unremarkable. The initial ECG showed T wave inversion in lead V1 and V2. And cardiac enzymes were elevated on the laboratory test. Echocardiogram showed normal left ventricular systolic function without definite regional wall motion abnormalities. The diagnostic impression was non-ST elevation myocardial infarction.
Baseline Coronary Angiogram & IVUS
  1. The right coronary angiogram showed diffuse but mild atherosclerotic plaque at the proximal to the distal portion of RCA ( Movie 1).
  2. The left coronary angiogram showed the anomalous origin of left main coronary artery (LMCA) arising from RCA ( Movie 2), and tight stenosis at the functional LMCA and the proximal LAD ( Movie 3).
Procedure
A 7-Fr sheath was inserted through the right femoral artery and the left coronary artery adjacent to the ostium of RCA was engaged with a 7-Fr JR 3.5 guiding catheter. 0.014-inch Sion blue 180 cm wire with Caravel¢ç microcatheter was inserted into LAD and 0.014-inch Sion blue 180 cm wire was replaced with 0.014-inch BMW (Powerturn) 300 cm wire. Pre-dilation was performed with a SAPPHIRE II 2.5 x 15 mm balloon by back-up support using Guide Liner extension catheter ( Movie 4). And a XIENCE Alpine 3.0 x 23 mm was successfully deployed at the functional LMCA to the proximal LAD ( Movie 5). Then, post balloon dilatations were performed using Lacrosse 1.0 x 5 mm, SAPPHIRE II 3.0 x 15 mm, and Nimbus Salvo 3.0 x 13 mm at the LMCA to the proximal LAD, sequentially ( Movie 6). The final angiogram ( Movie 7, Movie 8) and IVUS showed that the procedure was successful.

Appendix
IVUS image of pre-stent implantation ( Movie 9), post stent implantation ( Movie 10) and final image ( Movie 11) of LAD.

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