Slides
LM Bifurcation Lesion Treated by TAP Technique and Drug Eluting Balloon
- Operator : Duk-Woo Park
LM Bifurcation Lesion Treated by TAP Technique and Drug Eluting Balloon |
- Operator: Duk-Woo Park, MD |
Case Presentation |
A 56 year-old male was referred to our hospital for a second opinion. 4 years ago, he underwent primary PCI for the ST elevation MI and DES was implanted in LAD in other center. After index procedure, he underwent 4 times of additional balloon angioplasty due to in stent restenosis and side-branch occlusion. About 4 months ago, effort chest pain was recurred. He underwent coronary angiogram which revealed severe ISR at proximal LAD with concomitant involvement of LCX os. His coronary risk factor was ex-smoker and hyperlipidemia. His baseline ECG and cardiac markers were unremarkable. |
Baseline Coronary Angiography |
Procedure |
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL 4 catheter. The 0.014-inch 190cm BMW wire was inserted into the LAD and another BMW wire was inserted into the LCX. After IVUS, proximal to mid LAD was dilated with 4.0 X 15mm Tazuna balloon (Figure 1). The ISR lesion was successfully dilated with balloon angioplasty ( Movie 4). Two drug eluting balloons (Sequent please 3.5 X 20mm and 3.0 X 20mm) were applied subsequently to prevent restenosis (Figure 2). LCX was rewired with Choice PT 0.014 inch wire. After dilatation with 2.0 X 15mm Tazuna balloon, Promus premier (Synergy) 2.75 X 32 mm stent was implanted at proximal LCX (Figure 3). And then kissing ballooning was performed by using a 3.5 X 15 mm non-compliant (NC) Quantum balloon at LM to proximal LAD and 2.75 X 15mm NC Quantum balloon at LM to proximal LCX (Figure 4). Final left angiogram showed successful result ( Movie 5, Movie 6). |
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