Case

Ostial LM Disease with LAD Lesions

- Operator : William F. Fearon

Ostial LM Disease with LAD Lesions
- Operator: William F. Fearon, MD
Case Presentation
A 64-year-old man was was admitted with dyspnea on exertion. His risk factors were hypertension and dyslipidemia. The EKG is normal and cardiac biomarkers are normal. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality. Treadmill test showed positive negative and thallium test showed reversible large defect of LAD territory.
Baseline Coronary Angiography
The left coronary angiography showed 80% discrete stenosis of LM ostium, subtotal stenosis of proximal LAD, and diffuse 70% stenosis of mid LAD. ( Movie 1, Movie 2)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 7F JL catheter with 4 cm curve. Two 0.014 inch BMW wires were inserted into the LAD and RI. To evaluate the functional status of LM, FFR was done. FFR was normal (0.99 before adenosine and 0.93 after adenosine). After 0.014 inch BMW wire was inserted into the Di, predilatation was done using the Voyager Trek 2.5 X 15mm and Voyager NC 3.0 X 15mm. (Figure 1, Figure 2) After IVUS examination, Xience Prime 2.75 X 28mm and 3.0 X 23mm were deployed at the proximal to mid LAD. (Figure 3, Figure 4) After then, to evaluate the functional status of D1, FFR was done. FFR was normal (1.00 before adenosine and 0.86 after adenosine). However, there was a dissection of LM ostium on IVUS. So we deployed the Xience Prime 4.0 X 12mm stent at the LM ostium to distal LM even though the functional status of LM was normal. ( Movie 3) Final left angiogram showed that the procedure was successful. ( Movie 4, Movie 5)

Comments

  • Xue Yu 2014-04-20 How could the FFR of the tight ostium of LM be normal? Any explanation?

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