Slides

Severe Calcified LAD Ostial Lesion Treated with Simple Cross-Over Technique and Deferral of the PCI of Middle LAD Lesion on the Basis of FFR Value

- Operator : Seung-Jung Park

Severe Calcified LAD Ostial Lesion Treated with Simple Cross-Over Technique and Deferral of the PCI of Middle LAD Lesion on the Basis of FFR Value
- Operator: Seung-Jung Park, MD
Case Presentation
A 67 year old man was admitted with effort chest pain for 2months. He received a PCI on distal LAD (Taxus 2.5 x 16mm) and proximal RCA (Driver 4.0 x 24mm) in other hospital 6years ago. 6months after stent implantation, he underwent stent reimplantation with Taxus 3.5 x 16mm at the ISR site of proximal RCA in the same hospital. His coronary risk factors were hypertension, hyperlipidemia and smoking. The echocardiography showed normal left ventricular function (EF=62%) without regional wall motion abnormalities. Treadmill test and thalium SPECT were not done.
Baseline coronary angiography
The left coronary angiogram showed tight stenosis at LAD ostium and diffuse intermediate disease of middle LAD with severe calcification ( Movie 1, Movie 2). Distal LAD stent was patent. The right coronary angiogram showed mild disease with patent proximal RCA stent.
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8F XB 3.5 guiding catheter. Two 0.014 inch BMW wires were inserted into the LAD and LCX. After IVUS, we decided to use simple cross-voer technique without rotabulation. A LM to proximal LAD lesion was predilated with 3.0 x 15mm Maverick balloon and 3.5 x 15mm NC balloon (Figure 1). And then 4.0 x 20mm Promus element stent was implanted at LM to proximal LAD (Figure 2) with post-dilatation using a 4.5 x 8mm Quantum NC balloon. Final angiogram showed a good result with well-expanded stent. ( Movie 3, Movie 4) After the PCI at LM to proximal LAD, we measured a FFR value in the distal LAD and the FFR value was 0.81 during maximum hyperemia. So we decided to defer a PCI for the middle LAD lesion.

Comments

  • Jingjin Che 2011-06-02 Thank you for presenting of this perfect case. I just want to know what size of the deferred stent you planned to use? And in the movie 3, the segment after the old stent is very obscure, but FFR value is acceptale. how did the IVUS show in that area? how do you balance the result of the two measures, IVUS and FFR?

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