Slides
Heavy calcified LM to LAD stenosis treated by rotabulation and simple cross over stenting
- Operator : Seung-Jung Park
Heavy calcified LM to LAD stenosis treated by rotabulation and simple cross over stenting |
- Operator: Seung-Jung Park, MD |
Relevant clinical history and physical exam |
A 58 year-old woman visited our hospital because of recurrent episodes of dyspnea. She already underwent angiography and diagnosed as coronary arterial disease involved left main and triple vessels at outside hospital. Although bypass surgery was recommend as a primary treatment option, she was reluctant to surgery, therefore visited our hospital for secondary opinion. Her coronary risk factors were hypertension and smoking. |
Relevant catheterization findings |
Left coronary angiogram showed severe stenosis with heavy calcification diffusely involving from LM to mLAD artery.( Movie 1) Also right coronary angiogram showed diffuse stenosis with calcification involving whole segments. |
Procedural step |
First above all, to support the patient¡¯ hemodynamics during procedure, prophylactic IABP insertion was done. Then, Lt JL4 8Fr guiding catheter was engaged into the LMCA. Conventional 0.014 inch wires were inserted into LAD and LCX, respectively. For the delivery of balloon and stent, we needed several times of rotablation with 1.25(210000 burr) and 1.5mm(210000 burr) due to heavy calcification.( Movie 2) Thereafter, we could do the balloon dilatation using 2.5X2.75mm balloon upto 20 atm at proximal to mid LAD.( Movie 3) After rotablation and balloon inflation, we checked IVUS cautiously and placed the 3 consecutive Promus Element stents (3.5, 3.0 and 2.75mm) with simple cross-over technique from mLAD to LM.( Movie 4) Thereafter, post adjunctive balloon dilatation was done.( Movie 5) After kissing-balloon at proximal LCX and LAD at distal LM bifurcation,( Movie 6) we finished procedure. ( Movie 7, Movie 8) |
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