LM Treated by Decision Making Using with FFR (Fractional Flow Reserve) Guidance

- Operator : Seung-Jung Park

LM Treated by Decision Making Using with FFR (Fractional Flow Reserve) Guidance
- Operator: Seung-Jung Park, MD
Case Presentation
A 64 year-old man was admitted with effort chest pain for 6 months. He already underwent PCI with PROMUS Element stent (3.0 x 24mm) at dRCA 3 months ago. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality. Treadmill test is positive and thallium test showed reversible large perfusion defect of LAD territory.
Baseline Coronary Angiography
The left coronary angiogram showed diffuse 70 to 80% stenosis of LM ostium to proximal LAD, tubular 90% stenosis of middle LAD, and tubular 80% stenosis of 1st diagonal branch ( Movie 1, Movie 2, Movie 3). The previously inserted stent at dRCA was patent.
Procedure
A 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 8Fr JL 4 catheter with side hole. Three 0.014 inch BMW wires were inserted into the LAD, LCX, and Diagonal branch. We pre-dilated diagonal branch using a Maverick 2.0 x 15 mm balloon. A 2.5 x 18mm XIENCE Prime stent was directly implanted at diagonal branch LM to proximal LAD crossing LCX ostium without predilatation (Figure 1, Movie 4). And then, we pre-dilated mLAD using a Maverick 2.5 x 15 mm balloon. Thereafter, we deployed a XIENCE Prime 3.0 x 18mm at mLAD (Figure 2). After mLAD stenting, we checked LAD FFR value using a pressure wire. LAD FFR value was 0.74. Therefore, we deployed a XIENCE Prime 4.0 x 23mm at LM ostium to pLAD (Figure 3). Adjunctive post-stenting balloon dilatation was done using a Dura Star 4.0 x 15mm at LM to pLAD. After LM to pLAD stenting, LAD FFR value was 0.88. Final angiogram showed that the procedure was successful ( Movie 5, Movie 6).

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