Slides
Left Anterior Descending Bifurcation Lesion Treated with Provisional T Stenting
- Operator : Seung-Jung Park
| Left Anterior Descending Bifurcation Lesion Treated with Provisional T Stenting |
| - Operator: Seung-Jung Park, MD |
The patient is a 65 year old man with exertional chest pain for 6 months and resting chest pain for 3 weeks. His risk factors included hypertension and smoking. His baseline ECG was normal. His resting LV ejection fraction was 58% with no regional wall motion abnormalities. |
| Coronary Angiography |
Coronary angiogram showed a middle left anterior
descending artery (LAD) bifurcation lesion with proximal involvement (Figure
1, Figure
2, Figure
3). |
| Procedure |
An 8F 3.5 EBU guiding catheter was engaged at
the ostium of the left main coronary artery. Two Neos 0.014 inch guidewires
were placed into the LAD and the diagonal branch. The diagonal branch
and the LAD were pre-dilated with a Black Hawk balloon (2.5 X 20 mm) (Figure
4 ). Then, a Cypher stent (3.5 X 23 mm) was placed at the LAD bifurcation
at 16 atm (3.76 mm) (Figure
5 ). Because the narrowing of the diagonal branch was aggravated after
stenting (Figure
6 ), the diagonal branch was re-accessed with a Choice PT wire. A
kissing ballooning was performed with a stent balloon (3.5 X 25 mm) for
the LAD (at 10 atm, 3.33 mm) and an Apollo balloon (3.0 X 20 mm) for the
diagonal branch (at 20 atm, 3.6 mm). But, the narrowing of the diagonal
branch maintained. So, an additional Cypher stent (2.75 X 13 mm) was deployed
at the diagonal lesion at 18 atm (3.01 mm) with "T" stenting
technique (Figure
7 ). Afterwards, adjunctive high pressure dilation using a kissing
balloon technique was performed to achieve angiographic optimization (Figure
8 ). The final angiogram revealed optimal stent expansions without
significant residual narrowing in both branches (Figure
9 , Figure
10 ). |
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