Slides
FFR Guided Treatment of Distal LM to Proximal LAD Lesion with Jailed LCX
- Operator : Seung-Jung Park
| FFR Guided Treatment of Distal LM to Proximal LAD Lesion with Jailed LCX |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 58 year-old gentleman was admitted through ER due to recently aggravated chest pain. His coronary risk factors were hypertension, smoking, and hyperlipidemia. The physical exam was normal. The ECG and cardiac enzyme were unremarkable. Treadmill test was positive at stage 3. Thallium SPECT showed slow Tl-201 washout which meant suspicious multivessel disease. |
| Baseline coronary angiography |
1. The left coronary angiogram showed diffuse significant stenosis at distal LM to proximal LAD. Another significant stenosis at distal LAD was observed ( Movie 1, Movie 2, Movie 3, Movie 4).2. The right coronary artery was normal ( Movie 5). |
| Procedure |
| An 8 Fr JL 4 guiding catheter with side holes was engaged at the left coronary artery ostium through right femoral artery. At first, we performed intravascular ultrasound (IVUS) evaluation from LM to dLAD and at LCX. Minimal lumen area (MLA) was 1.0 mm2 at dLAD lesion and 2.7 mm2 at LM to pLAD lesion. LCX ostium showed mild stenosis on IVUS evaluation. And then, we checked the value of FFR at LAD and LCX using a pressure wire. The value of FFR was 0.52 at dLAD across the lesion, 0.73 at mLAD, and 0.87 at LCX under adenosine infusion via intravenous route. We planned to deploy stent at LM to pLAD. A Promus Element stent 4.0x32mm was directly deployed at LM to pLAD ( Movie 6). Following angiogram showed LCX ostium was significantly jailed ( Movie 7). So we measured the value of FFR at LCX. The initial value of FFR was 0.94, but the Post-PCI LCX value was decreased to 0.64. Thus, we dilated proximal LCX using a Maverick balloon 2.5x20mm. And then, we performed kissing ballooning with a Dura star NC balloon 4.5x20mm at LM to pLAD and a Maverick balloon 2.5x20mm at LM to pLCX ( Movie 8). Following angiogram showed successful ( Movie 9). After that, we checked the value of FFR at dLAD again. The value of FFR was 0.71 under adenosine infusion. So predilatation was performed with a Maverick balloon 2.5x20mm at dLAD. After predilatation, we deployed a Promus Element stent 2.75x20mm at dLAD. ( Movie 10) Final angiogram showed that procedure was successful, and final dLAD FFR value after intravenous adenosine was 0.82. ( Movie 11, Movie 12) |
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