Slides

Simple Strategy is Better for LAD Bifurcation Lesion

- Operator : Alan C. Yeung

Simple Strategy is Better for LAD Bifurcation Lesion.
- Operator: Alan C. Yeung, MD
Clinical presentation
A 63-year old man was admitted with intermittent resting chest pain for 3 months. His risk factors were hypertension and smoking. Baseline ECG showed nonspecific ST-T changes. Echocardiography showed mild LV dysfunction with hypokinesia of anterior and anteroseptal wall.
Baseline angiogram
1. Left coronary angiogram showed diffuse proximal to mid-LAD narrowing and suspicious narrowing of proximal diagonal branchs (Figure 1 and Figure 2).
2. Right coronary angiogram showed no abnormality.
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F JL catheter with 3.5cm curve. A 0.014 inch BMW wire was inserted into the LAD, and another 0.014 inch BMW wire into second diagonal branch. On IVUS study of LAD lesion, ostium of diagonal branches showed no significant narrowing. For LAD lesion, predilation was performed using a 2.5 X 20 mm Sprinter balloon at 8atm (2.5 mm) (Figure 3 and Figure 4). One 2.5 X 30 mm Endeavor stent was deployed from LAD os to proximal LAD at 12 atm (2.6 mm) (Figure 5), and consecutively another 2.5 X 18 mm Endeavor stent was deployed for mid-LAD lesion at 16 atm (2.71 mm) with overlap (Figure 6 and Figure 7). Additional balloon dilatation was done with Quantum balloon 3.0 X 12 mm upto 16 atm (3.07 mm), repetitively. Final angiogram showed a well-expanded stents with preserved flow to diagonal branches (Figure 8 and Figure 9).
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Comments

  • Marcelo Ribeiro 2007-11-27 The fact that ivus did not demostrate compromise of ostium of branches is reassuring, although it does not completely rule out the occurrence of snow plow effect.We usually protect these branches with a wire, and probably would have finished this case with kissing balloon, unless there is only a scar from previous MI in that area.

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