Author + information
Patient initials or identifier number
71 years male
Relevant clinical history and physical exam
A 71 years old male who had presented with angina of 1 week, a CAG done showed calcified LM-LAD with proximal 90% stenosis, he was attempted for PCI at outside hospital but unable to break the lesion, hence referred for further treatment
Relevant test results prior to catheterization.
Relevant catheterization findings.
LCA was cannulated with 7F EBU catheter, IFFR pullback showed 0.66, a run of OCT showed significant calcium with dissection in Mid LAD extending to LM. IVUS done confirmed flap in LM dissection and wire in true lumen. LM-LAD stented with 3.5 x 33 DES wire recrossed to LCX and predilated with 1.5 x 15 mm and 2.0 x 15 mm balloon followed by 3.0 x 33 DES stented to LCX. LM POT was done with 4.0 x 8 mm balloon, IVUS done showed well opposed stent, a final run of OCT also showed dilated stents with sealed off flap of dissection
LM dissection in a calcified LAD extending to LM could be a disastrous. OCT was quite convenient in showing dissection and wire position in true lumen. IVUS confirmed extension of flap to LM. LM bifurcation would be at ease with these imaging modalities