Slides
FFR guided PCI for jailed LCX
- Operator : Seung-Jung Park
| FFR guided PCI for jailed LCX |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 62 year-old man was admitted with effort chest pain for 1 week. His coronary risk factors were hypertension and diabetes mellitus. The echocardiography showed normal left ventricular function (EF=63%) without regional wall motion abnormality. Thallium scan showed reversible large sized perfusion defect of anterior wall and reversible medium sized perfusion defect of mid to basal inferolateral wall. |
| Baseline coronary angiography |
The right coronary angiogram showed tubular 90% stenosis of proximal RCA ( Movie 1). The left coronary angiogram showed diffuse 70 to 80% stenosis of proximal to distal LAD and tubular 70% stenosis of proximal to distal LCX ( Movie 2, Movie 3). |
| Procedure |
| An 8 Fr sheath was inserted through right femoral artery, and the right coronary ostium was engaged with a 7Fr JR 4 catheter with side hole. A 0.014 inch BMW wire was inserted into the RCA. We pre-dilated proximal RCA using a Sprinter legend 2.0 x 20 mm balloon. Thereafter, we deployed a XIENCE PRIME stent 4.0 x 18 mm at pRCA (Figure 1). Final right angiogram and IVUS showed that the procedure was successful ( Movie 4). Thereafter, we engaged an 8Fr XB3.5 catheter with side hole into left coronary ostium. Firstly, a 0.014 inch BMW wire was inserted into the LCX. We pre-dilated proximal to distal LCX using Sprinter legend 2.0 x 20 mm balloon (Figure 2). Another 0.014 inch NEO wire was inserted into the LAD. We pre-dilated middle LAD using Sprinter legend 2.0 x 20 mm balloon (Figure 3). Thereafter, we deployed a XIENCE PRIME stent 2.75 x 38 mm at middle to distal LAD (Figure 4) and a XIENCE PRIME 3.5 x 38 mm at LM to middle LAD (Figure 5). Adjunctive post-stenting balloon dilatation was done using a Dura star 3.5 x 20 mm at LM to pLAD (Figure 6). However, angiogram showed that LCX ostium was significantly jailed. So, we measured FFR. Resting FFR value was 0.88, but FFR value was decreased to 0.7 after adenosine infusion. Thus, we dilated proximal to distal LCX using Sprinter legend 2.0 x 20 mm balloon. And then we performed kissing balloon angioplasty with a Dura star 3.5 x 20 mm at LM to pLAD and a Dura star 2.5 x 20 mm at LM to pLCX (Figure 7). After kissing balloon angioplasty, post adenosine FFR value of LCX was 0.86. Final left angiogram and IVUS showed that the procedure was successful ( Movie 5, Movie 6). |
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