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Patient initials or identifier number
Relevant clinical history and physical exam
A 84-year-old man with diabetes mellitus, chronic renal disease and peripheral artery disease was referred to the emergency department with dyspnea on exertion. He was performed culotte stenting before 6-months because of the ostial bifurcation stenosis of the left circumflex coronary artery. He was shocked vital and the ECG showed ST depression in leads V2-6 and wide QRS.
Relevant test results prior to catheterization.
Relevant catheterization findings
Angiogram of the left coronary artery showed the severe prolonging in-stent stenosis from left main coronary artery to the ostium of left circumflex coronary artery.
Guiding Catheter Launcher(EBU 3.0) was engaged to the left coronary artery Floppy wire(Sion TM) placed in left circumflex coronary artery(LCx). Another floppy wire (Runthrough Extra floppy TM) placed in the left anterior descending branch(LAD), respectively. The lesion was dilated with two balloons (Powered Lacrosse 2 3.0/15 mm dor LAD and NC Traveler 3.0/12 mm for LCx) by using kissing balloon technique(KBT). Finally, after implantation of SynergyTM 2.75/38 mm stent from left main coronary artery to LCx and KBT, TIMI 3 flow was achieved.
Acute myocardial infarction due to unprotected left main coronary artery has a worse prognosis. Cardiac shock usually occur (54.5%) and the mortality rate is high (40%).We performed “Culotte stenting” to the ostial stenosis of the left circumflex coronary artery(LCx). However, the patient returned due to in-stent restenosis from a left main coronary artery to LCx ostium with cardiogenic shock. Any other effective initial procedure for this LCx ostial lesion?