Slides
Occluded Left Main Bifurcation Lesion Treated by Primary Stenting in the Setting of Acute Myocardial Infarction
- Operator : Seung-Jung Park
Occluded Left Main Bifurcation Lesion Treated by Primary Stenting in the Setting of Acute Myocardial Infarction |
- Operator: Young-Hak Kim, MD / Seung-Jung Park, MD, PhD |
Case Presentation |
The patient was 60 year-old male. He presented to the emergency room with persistent chest pain for 5 hours. He had a hypertension as a coronary risk factor. Baseline ECG showed ST elevation on precordial leads. Initial blood pressure was 70/30mmHg. He underwent emergent coronary angiography for primary PCI. |
Baseline Coronary angiography |
1. Left coronary angiogram showed subtotal LMCA bifurcation
lesion with TIMI 2 flow (Figure
1). 2. RCA was normal with grade 1 intercoronary collateral to left coronary. |
Procedure |
An 8F sheath was inserted through both femoral artery and IABP was initially inserted through left femoral artery. The left coronary was engaged with an 8F Judkins catheter through right femoral sheath. Coronary angiogram showed subtotal occlusion in distal left main coronary artery (LMCA) including bifurcation with TIMI 2 flow. LAD and LCX were wired with two floppy guidewires. And then, distal LMCA to proximal LAD was dilated with a 3.0mm x 20mm balloon at 6 atm (Figure 2), after which the following angiography revealed no compromise of flow of LCX (Figure 3). Thus distal LMCA to proximal LAD was stented with a 3.5mm x 16mm Express stent at 9 atm crossing over LCX (Figure 4). Unfortunately, we found that LCX ostium became more narrowed after stenting. Because the LCX was not small artery, we decided further dilatation of LCX with or without stenting. LCX was reaccessed with floppy guidewire through the strut of stent and dilated with a 2.5mm x 20mm balloon at 6 atm (Figure 5). Then, Kissing balloon inflation was performed in LMCA-LAD with a 3.0mm x 20 mm balloon at 6 atm and in LMCA-LCX with a 2.5mm x 20mm balloon at 6atm (Figure 6). Final angiogram showed no residual narrowing at LCX and LAD ostium without additional stenting in LCX (Figure 7). |
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