Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
Mr. MA, 45-year-old hypertensive, diabetic businessman presented with compressive chest pain on minimal exertion for 5 days. He experienced Acute anterior STEMI 10 days back and was treated with LMWH due to delayed arrival in a Non-PCI-capable hospital. On examination: Pulse-90 bpm, BP-120/70 mmHg, JVP-not raised, Lungs bases-clear.
Relevant test results prior to catheterization
Hb - 12 gm/dl
RBS - 10 mmol/l
S. Creatinine - 1.1 mg/dl
Troponin I - Negative
Electrolytes - Normal
ECG - RMI Anterior
Echo - Anteroseptal hypokinesia, EF 50%
Relevant catheterization findings
Coronary angiogram showed
LM - Normal
LAD - Ostio proximal 90% stenosis
LCX - Insignificant plaque
RCA - Dominant vessen & normal
The patient was loaded with 300 mg Aspirin & 300 mg Clopidogrel. 10,000 U Heparin was used. Left main coronary artery was hooked with 7f EBU guiding catheter. 2 floppies were used to cross LAD and LCX. The lesion was predilated with 2 x 15 semi-compliant balloon at 12 atm. A 3 x 20 mm DES with high visibility and good radial force were placed in a lesion. A 2.5 x 18 balloon was parked at LM to LCX for proper marking of LAD ostium so that there is no geographic miss. Several RAO caudal and LAO caudal view were taken for proper placing of a stent at LAD ostium then were deployed at 12 atm. Post dilation was done with a 3.5 x 10 mm NC balloon. There was no complication and TIMI III flow was achieved.
Precise stent placement may be difficult in complex LAD ostium lesion due to unwanted movement & angulation. Simultaneous balloon placement is a technically simple approach for prevention of unwanted stent movement. Keeping the balloon in LM to LCX during LAD ostial stent placement is a simple approach for prevention of unwanted stent movement & can be applied in clinical practice. This technique is quick, effective and technically simple for precise stent placement at LAD ostium. Further large scale studies into the optimal LAD ostial stenting are warranted to establish this technique.