Slides
Cypher Stents Implantation for Chronic Total Occlusion in Left Main Coronary Artery Bifurcation
- Operator : Seung-Jung Park
Cypher Stents Implantation for Chronic Total Occlusion in Left Main Coronary Artery Bifurcation |
- Operator: Seung-Jung Park, MD, PhD, Young-Hak Kim, MD |
Case presentation |
The patient was a 60 year-old male. He presented with effort chest pain for 6 months. His coronary risk factor was smoking. His baseline ECG and echocardiography showed normal findings. |
Baseline coronary angiography |
Left coronary angiogram showed chronic total occlusion at the left main (LM) bifurcation with retrograde filling by collateral flow from the right coronary artery (RCA) (Figure 1, Figure 2). |
Procedures |
Reopro was administrated just before the procedure. An 8F JL 3.5 guiding catheter was engaged into the LM ostium and the RCA catheter was also cannulated for simultaneous bilateral contrast injections. A 0.014 inch Shinobi wire was successfully introduced into the left anterior descending artery (LAD) under retrograde angiographic guidance by contrast injection from RCA. Balloon dilatations were performed from the middle LAD to LM ostium with a Hayate balloon (1.5 x 20 mm at 6 atm) and a Classic balloon (2.5 x 20 mm at 10 atm) (Figure 3, Figure 4). A 0.014 inch Floppy wire was also introduced into the left circumflex artery (LCX) and balloon dilation was performed with a Maverick balloon (1.5 x 20 mm at 20atm) (Figure 5). After recannalization in the LAD and LCX, the antegrade left coronary angiogram showed significant residual stenosis in LM bifurcation with involvement of LAD and LCX ostium (Figure 6). Therefore, a Cypher stent (2.5 x 33 mm at 12 atm) was deployed first in the middle LAD lesion (Figure 7). Then, another Cypher stent (3.5 x 33 mm) was placed from LMCA to proximal LAD overlapping with previous implanted stent in the middle LAD. After then, we planned to kissing stenting for the LM bifurcation because the LM was relatively large compared to the LAD and LCX. Therefore, the other Cypher stent (3.0 x 23 mm) was placed from the LM to the proximal LCX with aiming for kissing stenting (Figure 8). The LM-LAD stent was deployed first at 12 atm and the LM-LCX stent deployment was followed at 12 atm (Figure 9, Figure 10). Subsequently, kissing balloon dilatation was performed at 18 atm either (Figure 11). Final left coronary angiogram showed TIMI 3 flow without any residual in-stent narrowing in LMCA and both branches (Figure 12, Figure 13). |
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