Author + information
Patient initials or identifier number
Mr. R N
Relevant clinical history and physical exam
A 28-year-old gentleman nondiabetic, normotensive, dyslipidemic, nonsmoker presented to us with unstable angina.
ECG showed T inversion in anterior leads. Echocardiography showed good left ventricular systolic function with LVEF of 60%. Routine investigations were within normal limit.
Blood urea and creatinine level were within normal limit.
After initial medical management coronary angiogram was performed.
Relevant test results prior to catheterization
ECG showed T inversion in anterior leads. Echocardiography showed good left ventricular systolic function with LVEF of 60%. Routine investigations were within normal limit. Blood urea and creatinine level were within normal limit.
Relevant catheterization findings
Coronary Angiogram shows normal Left main stem. LAD type III good caliber vessel with subtotal occlusion after the origin of D2. D1 and D2 are fare caliber vessel with the significant ostio proximal disease. LCX is a good caliber vessel with a minor plaque in proximal segment. RCA is dominant good caliber disease free vessel.
RCA lesion was treated with a 3 x 23 mm DES initially.
Target lesion is LAD and Diagonals. LMCA was engaged with a 7F EBU 3.5 guide catheter. LAD and D2 were wired with two floppy wires.
Both the lesion were predilated with 1.5 x 10 mm followed by 2 x 12 mm semi-compliant balloon. A 2.75 x 32 mm DES implanted in LAD with 12 atm (nominal 9). Proximal optimization was performed with a 3 x 6 mm Non-compliant balloon at high atmospheric pressure. The lesion in D2 was stented with a 2.5 x 13 mm DES using TAP technique. Kissing balloon inflation was performed with a 2.75 x 6 mm NC balloon in LAD and 2.5 x 6 mm NC balloon in D2. Second POT was performed. D1 was treated with a 2.75 x 13 mm DES using TAP technique.
Final, kissing was performed with a 3 x 10 mm NC balloon in LAD and 2.75 X 10 mm NC balloon in D1.
Final, TIMI III flow was achieved in all the vessels. However, a distal edge dissection noted in LAD which was treated with another 2.5 X 19 mm DES.
T and the minimal protrusion are a very useful technique for the treatment of complex coronary artery bifurcation lesion. Although, many other techniques are there for the treatment of coronary artery bifurcation lesion. Recent BBK2 trial shows culotte technique is better than TAP. However, in coronary artery bifurcation lesion with favorable angle TAP remains a very useful technique as in our case.