Slides
Two bifurcation lesions, treated with different technique
- Operator : Seung-Jung Park
Two bifurcation lesions, treated with different technique |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 71 year old man was admitted with unstable angina pectoris. 5-years ago, he had got stenting at right coronary artery and he was on the regular medication. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=65%) without regional wall motion abnormality. |
Baseline Coronary Angiography |
The left coronary angiogram showed very tight stenosis at distal left main (LM) bifurcation lesion. Also, at the mid-LAD bifurcation, there was tight stenosis. ( Movie 1, Movie 2) The right coronary angiogram showed patent previous stent with mild diffuse stenosis. |
Procedure |
An 8 Fr EBU 3.5 guiding catheter was engaged into the left main ostium. Three 0.014 inch Floppy wires were introduced into the LAD, LCX, and 1st Diagonal (D1). ( Movie 3) And then we did IVUS examination; IVUS findings in Diagonal branch showed large plaque burden and very tight stenosis at ostium( Movie 4), however, IVUS finding in circumflex artery showed quite big vessel size and relatively big lumen area( Movie 5). Based on the IVUS findings, we decided treatment strategy for treatment of two bifurcation lesion. We performed balloon dilatation at the distal LM to the proximal LAD with Sprinter 2.5 x 15mm. Using with a Sprinter 2.5 x 15mm, predilation was performed for diagonal branch. ( Movie 6) And we deployed a Promus Element Stent 2.75 x 20mm across bifurcation site of D1. ( Movie 7) The balloon (Dura Star 3.0 x 15mm) in the mid- LAD was expanded after removing the wire at D1. ( Movie 8) After re-wiring of 0.014 inch Floppy wire at D2, the balloon dilation with Sprinter 2.5 X 15mm was performed at the mid-LAD and then a Promus Element Stent 3.0 x 28mm was expanded in the LAD. ( Movie 9) For the final kissing balloon dilation, the D1 was rewired with 0.014 inch Floppy wire; and balloon dilation was performed using with an Ikazuchi 1.5 x 15mm. Then, final kissing balloon dilation was performed with a Voyager NC 3.0 x 15mm in the LAD and an Ikazuchi 2.5 x 15mm in D1. ( Movie 10) We planned cross-over technique from LM to LAD across LCX. Then, a Promus Element stent 4.0/28 mm was placed at the proximal LAD to the LMCA at 10 atm. ( Movie 11) After re-wiring with 0.014 inch Floppy wire at the LCX, the kissing balloon dilation was performed with a Stent balloon 4.0 x 28mm in the LM and a Sprinter 2.5 x 15mm in the LCX. ( Movie 12) Final angiogram showed well-expanded and well-positioned stents. ( Movie 13, Movie 14) |
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