Left Main Ostial Disease with Significant Proximal LAD Lesioin Treated with Cross-Over Technique Using Single Paclitaxel-Eluting Stent
- Operator : Gregg W. Stone
|Left Main Ostial Disease with Significant Proximal LAD Lesioin Treated with Cross-Over Technique Using Single Paclitaxel-Eluting Stent|
|- Operator: Gregg W. Stone, MD|
|A 62-year-old woman was admitted due to effort chest pain for 4 years. Her risk factor was hypertension. Coronary CT showed significant narrowing at ostial LM and proximal LAD. The electrocardiogram normal and the treadmill test was positive at stage II. Her left ventricular function was normal.|
|Baseline coronary angiogram|
1. Left coronary angiogram showed a significant narrowing at LMCA ostium and proximal LAD (Figure
1, Figure 2).
2. Right coronary angiogram was normal.
|An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 7F 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). IVUS examination showed non-significant plaque burden at the ostial LCX and severe atheromatous plaque burden at proximal LAD with heavy calcification. Predilation of proximal LAD was achieved with a cutting balloon 3.0 X 10 mm by 6 atm (3.0 mm) (Figure 4). Then, another 0.014 inch BMW wire was inserted into the diagonal branch (Figure 5). A 3.0 X 24 mm Taxus Liberte stent was positioned at the ostial left main to proximal LAD and deployed by 16 atm (3.34 mm) (Figure 6, Figure 7). Postdilation was done with Quantum balloon (4.5 X 8 mm) by 16 atm (4.61 mm) at LMCA (Figure 8). Post-stent IVUS revealed satisfactory result without malapposition of the stent. Final angiogram showed a well-expanded stents without residual narrowing (Figure 9, Figure 10).|
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