Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 56 year-old woman presented with symptoms of angina during exercise and got worse gradually. She denied systemic disease. In physical examination, no obvious cardiac murmur or other positive findings were noted.
Relevant test results prior to catheterization
Treadmill test showed positive finding.
Relevant catheterization findings
A diagnostic angiogram revealed a significant ostial lesion of a left anterior descending artery (LAD). Intravascular ultrasound was performed in LAD and in a left circumflex artery (LCX) which showed no significant stenosis or plaque at ostial-LCX.
An Absorb BVS 3.5 x 28 mm was deployed at distal left main (LM) to ostial-LAD and followed by in-stent high pressure with a Quantum balloon 4.0 x 15 mm (Boston, U.S.A). Junctional bradycardia and shock status happened after then. The vasoactive agent given and intra-aortic balloon pump (IABP) was set up immediately. Repeat angiogram showed LCX much occluded. After 0.014 run through Floppy wire passed through scaffolds, a Maverick 2.0 x 20 mm balloon (Boston, U.S.A.) inflated at LM to LCX. A bail-out drug-eluting stent Xience Xpedition 3.0 x 12 mm (Abbott Vascular, Santa Clara,California) was deployed at ostial-LCX as a T-stent technique. Alternative ballooning performed at LM-LAD and LM-LCX. Optical coherence tomography (OCT) showed will deploy BVS. IABP removed two days later and the patient denied any discomfort during 6-months follow-up duration.
Percutaneous coronary intervention from LM to LAD with BVS could be safe and feasible, but the complications such as LCX total occluded may happen even through no diseased side branch. Therefore, the use of BVS implantation for LM bifurcation need more consideration.