Slides

Left Main Ostial Stenosis Treated with a Single Sirolimus-Eluting Stent Implantation

- Operator : Seung-Jung Park

Left Main Ostial Stenosis Treated with a Single Sirolimus-Eluting Stent Implantation
- Operator: Seung-Jung Park, MD, Ki Bae Seung, MD,

Clinical Presentation

A 76-year old man was admitted due to resting chest pain for 15 days. His coronary risk factor was diabetes mellitus. His baseline ECG and LV function were normal.

Baseline Coronary Angiogram

1. Left coronary angiogram showed a significant left main coronary artery (LMCA) ostial narrowing (Figure 1, Figure 2).
2. Right coronary angiogram was normal.

Procedure

An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 3.5 cm curve. Two 0.014 inch BMW wires were inserted into the left anterior descending artery (LAD) and left circumflex artery (LCX), respectively (Figure 3, Figure 4). IVUS examination showed non-significant plaque burden at the ostial LCX (Figure 5) and modest plaque burden at the distal LMCA (Figure 6). Therefore, a 3.5 X 18 mm Cypher stent was positioned at the LMCA extending to the ostial LAD and deployed at 16 atm (3.72 mm), crossing the LCX (Figure 7). And then, additional balloon inflation was performed with a 4.0 X 12 mm Sprinter at 15 atm (4.42 mm) for stent optimization (Figure 8). Final angiogram showed well-expanded stents without residual narrowing (Figure 9, Figure 10).
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Comments

  • Sriram 2006-07-21 Respected Sir, I admire your strategy of covering the distal LMCA and protecting the entire stem. However i would like to know whether you had in mind of a kissing balloon technique or simultaneous kissing because of plaque in the LCx. Secondly do you also think that there could have been a damage to the polymer.
  • mohsen Dehgani MD 2006-07-24 i think Quantum Mavrick balloon is the best balloon for postdilatation i recommend for postdilatation Quantum Maverick balloon 3.5-12
  • SanjaySrivatsa 2006-07-30 Does the size of the finally deployed cypher stent side cell covering the ostium of the LCX influence your decision to dilate the ostium of the LCX in the absence of overt disease there? What is the risk of subacute stent thrombosis at this location when there is gross mismatch between the side cell opening size at full deployment and the ostial size of the covered vessel? I think Ormiston has done some interesting benchwork studies looking at this but in the context of polymer cated stents and the flow rheology at bifurcations-this may be important?!
  • Jae Sik Jang 2006-08-10 Because of non-significant plaque burden at the LCX ostium, we didn't plan kissing stenting or final kissing balloon, and final angiogram reveald good result without compromise of LCX. If we perform kissing balloon, polymer damage might be expected. Side cell size of stent covering the ostial LCX maybe important in this case and risk of subacute stent thrombosis rises substantially in case of mismatch between the size of side cell and the actual size of the ostium covered. Thank you for your comment!.

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