Left Main to Proximal LAD and LCX Disease Treated by Simple Cross-Over Stenting

- Operator : Seung-Jung Park

Left Main to Proximal LAD and LCX Disease Treated by Simple Cross-Over Stenting
- Operator: Seung-Jung Park, MD
Case Presentation
A 64 year-old man was admitted with effort chest pain for a year. His coronary risk factors were hypertension, hyperlipidemia and ex-smoking. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=65%) without regional wall motion abnormality. Treadmill test was positive at stage 3 and thallium SPECT showed large reversible perfusion defect of LAD territory.
Baseline Coronary Angiogram
  1. A left coronary angiogram showed significant stenosis of LM ostium to proximal LAD, significant tight stenosis of proximal LCX. Additionally, intermediate stenosis were observed at OM1 ( Movie 1, Movie 2, Movie 3).
  2. A right coronary angiogram showed tubular 40% narrowing of PDA ostium ( Movie 4)
Procedure
An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8 Fr JL 4.0 catheter with side holes. Then 0.014-inch 190 cm BMW wire and 0.014-inch 180 cm Sion wire were inserted in LAD and LCX sequentially. Firstly tight stenosis of proximal LCX lesion was predilatated with Trek 2.5 x 20 mm balloon. Resolute Integrity stent 2.75 * 22 mm was implanted at proximal LCX. (Figure 1) After treating proximal LCX lesion, we performed IVUS evaluation of middle LAD to LM os lesion. IVUS imaging revealed that LCX ostium was preserved, simple cross-over stenting was performed. Direct stenting with Resolute intergrity stent 3.0 x 38 mm was done at LM ostium to proximal LAD. Because of stent under-expansion, instent post dilatation was done with Empira NC 3.5 x 20 mm balloon upto 12 atm at pmLAD and upto 28 atm at LM. (Figure 2). The Final angiogram showed that the procedure was successful ( Movie 5, Movie 6).

Comments

  • Bing Liu 2014-07-26 Nice case and good strategy and acute result. Pt will have a good outcome.
  • Long Bui 2014-07-27 Very nice case with good result. What's the antiplatelet therapy for this patient?
  • Anshul K Jain 2014-07-31 great case!

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