Slides
Left Main Bifurcation Intervention with Debulking Atherectomy and Cypher Stent Implantation
- Operator : Seung-Jung Park
Left Main Bifurcation Intervention with Debulking Atherectomy and Cypher Stent Implantation | |
- Operator: Seung-Jung Park, MD | |
Clinical presentation |
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A 67-year old man was admitted due to unstable angina for 1 month. His coronary risk factors were hypertension and smoking. Echocardiography showed normal ejection fraction without wall motion abnormality. |
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Baseline angiography |
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Left coronary angiogram showed distal left main coronary artery (LMCA) bifurcation lesion with the involvement of ostia of left anterior descending artery (LAD) and left circumflex artery (LCX) (Figure 1, Figure 2). Right coronary angiogram was normal. |
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Procedure |
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An 8F sheath was inserted through the right femoral artery and the left coronary was engaged with an 8F EBU 3.5. At first, left main to LCX was wired with 0.014" Floppy wire (Figure 3). Then, wiring of left main to LAD was tried with 0.014" Choice PT, Shinobi and Soft wire. But, wire passage to LAD was not easily performed. So, the 7Fr DCA device (3.5-4.0mm) was advanced into the proximal LCX and three cuts were done in order to facilitate wiring into the LAD. And then, successful wire advancement was performed into the LAD. After predilation with a Maverick 2.5mm x 20mm upto 2.5mm (8atm), LMCA and LAD ostium was stented with a 3.5 mm x 23 mm Cypher stent at 18 atm crossing the LCX ostium (Figure 4). Following angiogram showed a compromise of the LCX ostium (Figure 5). Thus, the LCX ostium was dilated with a 3.0mm x 20mm Sprinter balloon at 14 atm and followed by simultaneous kissing balloon dilatation with a 3.0mm x 20 mm Maverick balloon at 10 atm in LMCA-LAD and a 3.0mm x 20mm Sprinter balloon at 14 atm in LMCA-LCX (Figure 6). Final angiogram showed a good result (Figure 7, Figure 8). |
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