Slides
Left Main Bifurcation Lesion. Is Simple Stenting Cross-over Enough?
- Operator : Seung-Jung Park
Left Main Bifurcation Lesion. Is Simple
Stenting Cross-over Enough? |
- Operator: Seung-Jung Park, MD, Seong-Wook Park, MD, |
Clinical Presentation |
A 65-year old man was admitted with resting chest pain for 15 days. His coronary risk factor was diabetes. Baseline ECG showed nonspecific ST-T changes in anterior leads. Echocardiography showed a hypokinesia of right coronary artery (RCA) territory and normal left ventricular systolic function (EF = 56%). |
Baseline Coronary Angiogram |
1. Left coronary angiogram showed a distal left
main coronary artery (LMCA) bifurcation stenosis and diffuse narrowing
at middle left anterior descending artery (LAD) (Figure
1, Figure
2, Figure
3). |
Procedure |
A 7F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL 4 catheter. Two 0.014 inch Asahi Neo¡¯s soft wires were sequentially inserted into the LAD and left circumflex artery (LCX) (Figure 5, Figure 6). At first, one Cypher stent was deployed at the proximal to middle LAD [3.0x28 mm upto 3.15(14 atm)] (Figure 7). And then, predilation of distal LMCA to proximal LAD was achieved with a Sprinter 3.0x20 mm upto 16atm (3.36mm) (Figure 8). After predilation, a 3.5x23 mm Cypher stent was positioned at the LMCA ostium to proximal LAD and deployed upto 16 atm (3.72 mm) (Figure 9). Additional high-pressure balloon was performed with a 4.0x15 mm Sprinter upto 14 atm (4.26 mm) (Figure 10). Final angiogram showed well-expanded stents without compromise of LCX and residual narrowing (Figure 11, Figure 12). |
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