Slides

Multiple Vessel Coronary Intervention with Drug-Eluting Stents

- Operator : Seung-Jung Park

Multiple Vessel Coronary Intervention with Drug-Eluting Stents
- Operator: Seung-Jung Park, MD
Case Presentation

A 56 year-old woman presented with a exertional chest pain for 6 months . She had diabetes mellitus and hypercholesterolemia as coronary risk factors. Cardiac enzymes including CK-MB and Troponin I were in normal range on admission. Echocardiography showed normal LV ejection fraction of 59% with regional wall motion abnormalities in left anterior descending artery (LAD) and right coronary artery (RCA) territories.

Baseline Coronary Angiography

Baseline Coronary Angiography
Coronary angiogram showed diffuse tight narrowing at ostial left main (LM) with diffuse involvement of the LAD, distal left circumflex artery (LCX) and RCA (Figure 1, Figure 2, Figure 3).
Procedure

An 8F sheath was inserted through the right femoral artery and the RCA was engaged with an 8F JR 3.5 catheter. A 0.014 inch guidewire was placed into the RCA. Predilatation was performed with a 2.5 X 20mm Black-Hawk balloon at 6 atm (2.55mm). Then, a 3.0 X 33 mm and a 3.5 X 13 mm Cypher stents were implanted consecutively at the RCA lesions with overlapping at maximal pressure of 18 atm (3.84mm). The left coronary ostium was engaged with an 8F JL 3.5 catheter. A 0.014 inch Neos guide wire was placed into the LAD. Predilatation was performed with a 2.5 X 20 mm Black Hawk balloon at 16 atm (2.77mm). Then, a 2.75 X 33mm and a 3.0 X 33 mm Cypher stents was implanted from the middle LAD to the LM with overlapping. Finally, the distal LCX lesion was treated a 2.75 X 33mm Cypher stent implantation at 20 atm (3.05mm). Final angiogram showed good results (Figure 4, Figure 5, Figure 6, Figure 7, Figure 8).

Comments

  • Nicolaus J. Reifart 2005-01-16 Why not do the LCX before the LM-LAD-Stenting?
  • Young-Hak Kim 2005-01-20 Before LM intervention, the LCX was treated by balloon angioplasty with an acceptable result. However, after LM stenting, the LCX looked to be deteorated and stented.
  • Marcelo Ribeiro 2005-01-31 Recently, because of retrograde dissection to the left main,i had a similar case, considering the length of stented segment from the middle third of LAD to the ostium of the LM .And also, there was no significant compromise of the ostium of the LCX, which originated at a generous angulation from LAD.Do you think that the struts traversing the ostium of LCX should allways be dilated?Congratulations !
  • Young-Hak Kim 2005-01-31 In this particular case, we need not predilate the LM stent strut to cross the LCX stent. Stenting strategy should be decided depending on each case.
  • park mi-hyang 2005-04-30
  • Zhonghan Ni 2007-11-02 Dr Kim:As we know,Judkins catheter doesn't supply enough support in tackling complex leisions,although with it to cross a long stent without predilating the LM stent strut was acheived,is there chance destroying the polymer and eluting drugs?

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