PERCUTANEOUS CORONARY INTERVENTIONS

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Left main to LAD crossover stenting for LAD osteal stenosis

Operators:Assoc. Prof. Mutlu Vural

SBU Bağcılar Training and Research Hospital

Introduction

A 42 year-old man had class IV angina and non-ST elevation MI. Coronary angiogram showed LAD osteal disease (Video 1, Video 2). LCx ostium was clear. The RCA was patent (Video 3). Our approaches could be Afzal’s method (I like to say V stent-balloon technique, LM-to-LAD crossover stenting, Szabo or floating techniques. I prefered LM-to-LAD crossover stenting.

Procedure

We started with the JL 4.0 7 Fr guide catheter. We have deliverred a 4.5×24 mm stent following a 3.0×20 mm predilatation balloon (Video 4). Post dilatation was performed with 5.0×20 balloon at 16 atm (shortest available 5.0 balloon at that moment) (Video 5).  Final result was satisfactory, the procedure was concluded (Video 6, Video 7).

In summary, I am using 2 techniques as patient-oriented in  the treatment of Medina 0.1.0 LM distal lesions (LAD osteal stenosis). These are  LM-to-LAD crossover stenting, as you see, and Afzal’s Technique (I am calling V-stent-balloon). In the latter one, the stent extends from LAD osteal to LM in a limited extent and procedure was finished with kissing balloon (stent balloon and LCX balloon parked before stent dilatation) . I usually prefer LM-LAD crossover stenting in patients with large LAD and LM . I’m closer to the Korean notion, but I’m blending other data with patient focus. I sincerely respect my colleagues who have contributed.

 

Video 1

Video 2

Video 3

Video 4

Video 5

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Video 7

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