LMCA stenosis Treated by Simple Cross-Over Stenting

- Operator : Seung-Jung Park

LMCA stenosis Treated by Simple Cross-Over Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 52 year-old gentleman was admitted with effort chest pain for one month. His coronary risk factor was current smoking. The treadmill test was early terminated due to chest discomfort at stage two without EKG change. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=69%) without regional wall motion abnormality. Thallium SPECT showed reversible large sized perfusion defect at LAD territory.
Baseline Coronary Angiogram
1. A left coronary angiogram showed significant narrowing of left main coronary artery ( Movie 1, Movie 2, Movie 3, Movie 4).
2. A right coronary angiogram was normal.
Procedure
An 8 Fr sheath was inserted through right femoral artery, and the left coronary artery ostium was engaged with an 8 Fr JL 4.0 catheter with side hole. First, we inserted a BMW 0.014-inch guidewire into LAD. A Soft 0.014-inch guidewire was inserted to protect the LCX. We examined lesion with IVUS( Movie 5; LAD, Movie 6; LCX). Xience Prime stent 4.0 x 23mm was implanted at LM to pLAD without predilatation. Thereafter, post-stenting adjunctive balloon dilatation was done by using a stent balloon (Figure 1, Figure 2). The following coronary angiogram showed well-expanded LM stent, not-jailed LCX artery ( Movie 7, Movie 8).

Comments

  • Anwar Khan 2012-02-25 Did you check IVUS after jailed LCX stenting ? what are the chances of restenosis in jailed LCX with these types of results ?
  • Ajay Gandhi 2012-03-02 ? distal LM stenosis
  • Xuebo Liu 2012-03-05 Pre-IVUS imaging showed no much plaque at ostial LCX, how about the final ostial LCX hazy apperance on angiogram? If just carina shift, is it better to do kissing balloon dilation although the narrowing is not tight and have good TIMI flow?
  • Arash Gholoobi 2012-04-03 May be a good case for Axxess stent

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