Slides
Treatment of LM ostial in-stent restenosis lesion
- Operator : Seung-Jung Park
Treatment of LM ostial in-stent restenosis lesion |
- Operator: Seung-Jung Park, MD |
Clinical History |
A 52-year old woman was admitted for minimal effort chest pain for 1 month. 1 year ago, she had got PCI at LM ostium with Xience (4.0*15mm). Her cardiovascular risk factors were hypertension and diabetes. In her echocardiographic exam, LVEF was preserved without regional wall motion abnormality. |
Coronary angiographic findings |
Right coronary angiogram showed normal RCA with collateral flow to LAD.( Movie 1) |
Procedure |
A 8 Fr sheath was inserted into the right femoral artery and 5 Fr sheath was also inserted into left femoral artery for preparation of IABP use. Left coronary ostium was engaged with a 8 Fr JL 3.5 guiding catheter. A 0.014 inch BMW wire couldn¡¯t be inserted LMCA ISR lesion. After changing wire to 0.014 inch Choice PT with FINECROSS(micro-guide catheter), wiring could be performed into LAD and LCx. (Figure 1) On IVUS exam, large plaque burden with soft atheroma was showed in the LM ISR lesion.( Movie 3) We pre-dilated with Sprinter 2.5*15mm at LMCA ISR lesion ( Movie 4) and we dilated with cutting balloon 3.5*10mm 4 times. After cutting ballooning, we used non-compliant balloon, Nimbus Salvo 4.0*13mm and also used the drug coating balloon, SeQuent Please 4.0*17mm up to 7atm for 60 seconds. ( Movie 5) We performed Kissing stenting with Xience stents (dLM-LAD: 3.0*23mm /dLM-LCx: 3.0*28mm). After Kissing stenting, we performed kissing balloon with Durastar 3.0*15mm at LM-pLAD and stent balloon at LCx. Final IVUS and coronary angiogram showed successful PCI at LMCA and bifurcation lesion. ( Movie 6, Movie 7) |
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