PERCUTANEOUS CORONARY INTERVENTIONS

Coronary

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LM-LAD crossover stenting for LAD osteal stenosis

Operators:Assoc. Prof. Mutlu Vural
Dr. Diamant Lulaj

Bağcılar Education and Research Hospital

Case Summary

A 41-year-old woman is admitted to ER in another hospital because of chest pain. She developed VF. After a short-term CPR and defibrillation were  applied. Then she was referred to our center.  Her ECG revealed symmetric T-wave negativity on precordial V1-V5 with troponin positivity. On coronary angiography, a LAD osteal lesion was detected (Video 1). Since the LCX and LAD were superposed, the ostium locations were shown at a modified projection between AP caudal and spider view. RCA is small caliber vessel (Video 2).

Procedure

An 8Fr JL 4.0 guiding catheter was used. Both LCX and LAD were wired. A 4.0×20 mm balloon was parked in the LAD ostium (Video 3). During lesion predilatation, balloon jumping was observed. Because a LAD osteal dissection was evident (Video 4), a 4.5×29 mm  LM to LAD crossover BMS stent was implanted.  Stent was first inflated  at 12 atm to its nominal value. The balloon then was pulled back proximally and inflated again at 20 atm ( Figure 1 and Figure 2). On next imaging, POT was planned for LAD and LM (Video 5). As a result, a  5.0×10 NC balloon escalated inflations for LAD ostium to LM with flaring at the end ( Figure 3 and Figure 4). Final result was satisfactory (Video 6).

 

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