Slides
Side-branch protection with multiple wiring in diffuse long lesion
- Operator : Seung-Jung Park
Side-branch protection with multiple wiring in diffuse long lesion |
- Operator: Seung-Jung Park, MD |
Clinical History |
A 75-year old man was visited out-patient clinic for recent effort chest pain. After routine evaluation, He was admitted due to Treadmill test result (Stage 2, Positive). His cardiovascular risk factors were history of stroke 15 years ago and dyslipidemia. In his echocardiographic exam, LVEF was preserved without regional wall motion abnormality. |
Coronary angiographic findings |
Right coronary angiogram showed 30-40% stenosis at pRCA and 60-70% diffuse stenosis at dRCA.(FFR value of dRCA was 0.81) ( Movie 1) Left coronary angiogram showed sub-total occlusion at pLAD and diffuse stenosis at mLAD(FFR value at mLAD was 0.67) with multiple significant stenosis at diagonal branches ( Movie 2, Movie 3). |
Procedure |
A 7 Fr sheath was inserted into the right radial artery and left coronary ostium was engaged with a 7 Fr JL 4.0 guiding catheter. A 0.014 inch BMW wire was inserted to LAD. For protecting multiple diseased diagonal branches, we inserted 0.014 inch NEO¡¯s soft wire into 4th diagonal branch, 0.014 inch Runthrough NS wire into 1st diagonal branch and 0.014 inch Choice PT wire into 2nd diagonal branch ( Movie 4). And then, pre-dilatation was done with Maverick 2.5*15mm and two Xience stents (2.75*28mm, 3.5*38mm) were overlapped at dLAD to dLM ( Movie 5, Movie 6). After stenting, IVUS exam was done and we did high pressure balloon with Quantum 3.5*15mm at mdLAD, 4.0*15mm at pLAD to dLM. Final IVUS and angiogram showed successful PCI at dLAD to dLM with protection of diseased diagonal branches ( Movie 7). |
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