Slides
FFR guided PCI for tandem lesions in prox-to-mid LAD
- Operator : Seung-Jung Park
FFR guided PCI for tandem lesions in prox-to-mid LAD |
- Operator: Seung-Jung Park, MD |
Clinical history |
A 63 year-old female was presented with stable angina pectoris. Her coronary risk factors were hypertension, diabetes, and hyperlipidemia. Thallium SPECT showed reversible medium sized mild-to-moderately decreased perfusion in apical-mid anterior wall and treadmill test was positive at stage 4. |
Baseline coronary angiogram |
1. A right coronary angiogram showed mild atherosclerosis at mid RCA.(Figure 1) |
Procedure |
We focused on the LAD lesion which was corresponded to the result of thallium SPECT. Left coronary artery was engaged with an 8Fr JL 4 guiding catheter with side holes and LAD was crossed with a 0.014¡± BMW guidewire. We advanced a 0.014¡± pressure wire into the LAD along the previous giuidewire and removed the BMW guidewire. After adenosine infusion to get a maximum hyperemia, FFR value in distal LAD was 0.67. We couldn¡¯t pass an IVUS catheter distal to the very tight stenosis in the mid LAD. After predilatation with a 2.5 x 20 mm non-compliant balloon (Dura Star¢ç), we get an IVUS image showing two tight stenoses between 1st and 2nd diagonal branch with relatively normal segment just beyond the big septal branch.(Figure 4) A 2.75 x 28 mm Cypher stent was deployed in the mLAD with proximal stent landing on the normal segment just distal to the septal branch(Figure 5). After post dilatation using the 2.5 x 20 mm non-compliant balloon (Dura Star¢ç), we performed reexamination of FFR, and got a value of 0.90 within the segment between the septal branch and proximal part of stent and 0.90 distal to stent, respectively.(Figure 6) We decided not to stent the proximal lesion and finished procedure.( Movie 1) |
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