Author + information
- Indulis Kumsars1
Patient initials or identifier number
Relevant clinical history and physical exam
A 69 years old male with stable angina pectoris CCS- III. Risk factors: hypercholesteremia, hypertension. Previous anterior wall myocardial infarction. Preserved ejection fraction on Echocardiography. Previous PCI with DES on LAD.
Relevant test results prior to catheterization.
Relevant catheterization findings
Coronary angiogram revealed 75% stenosis in Left Main.
Guiding catheter 7Fr. Guide-wires in LAD and LCX. Vessel dimension assessment with IVUS. LCX and LM predilatation with cutting balloon. BRS implantation in LCX ostium. BRS postdilatation with non-compliant balloon. DES implantation from LM to LAD after predilatation with non-compliant balloon. Final kissing-balloon dilatation with two non-compliant balloons. Result optimization with LM postdilatation with short balloon (POT). Result assessment with IVUS and OCT. The patient was scheduled for coronary angiography and OCT follow-up after three years.
Intracoronary imaging is required a tool for Left Main intervention. Hybrid strategy with BRS and DES could be a good treatment option in selected Left Main cases. Pre-treatment with cutting-balloon is an important step before BRS implantation.