LIMA-LAD Complex PCI in Acute Anterior MI

Operators:Prof.Dr.Şevket Görgülü

Acibadem University, Kocaeli Acıbadem Hospital

Case Summary

A 62 year-old male with old bypass surgery admitted to our hospital with acute anterior myocardial infarction.


On coronary anjiography, RCA and LCX saphenous graft vessels were 100% occluded (Video 01). Total occlusion of  native LAD and LAD-LIMA graft was observed (Video 02). Chronic total occlusion of the RCA (Video 03) and LCX both of which are retrogradely perfused by bridge collaterals were seen.  Radial-diagonal graft was patent (Video 04). Because standart technique had been unsuccessful, left brachial approach was preferred due to previously harvested radial artery for a by-pass conduit. LAD-LIMA osteal stump was engaged with a modified pigtail by cutting the first part of the pigtail to create a hook (Video 05). Corsair was sent from the inside of the modified pigtail (Video 06). Corsair was crossed to distal LIMA (Video 07). Pigtail was removed after leaving a floppy 300 cm in the LIMA (Video 08). Right guiding catheter was advanced with the help of a Terumo hydrophilic wire to engage LIMA ostium (Video 09). LIMA engagement was only possible with an extension guideliner (Video 10), graft angiography was performed (Video 11). An 3.5×28 Xience V stent positioning was done (Video 12) After direct 3.5×28 Xience V Stent deployment (Video 13), a 4.5×8 NC was used at 25 atm for postdilatation (Video 14). Spasm at the end point of the stent was occurred (Video 15). After, ongoing spasm was detected (Video 16). Final angiogram after postdilatation and intracoronary nitrate (Video 17).

Nurse: Buse Taşdemir
Angio Technician: İsmail Topaç

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Original Techniques