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Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases

Identification and Treatment of a Special LMCA Bifurcation Lesion. Liu Xuebo. Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases. Case presentation. 56-year-old man Effort chest pain for 5 year ， aggravating 4 months

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Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases

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  1. Identification and Treatment of a Special LMCA Bifurcation Lesion Liu Xuebo Zhongshan Hospital, Fudan University Shanghai Institute of Cardiovascular Diseases

  2. Case presentation • 56-year-old man • Effort chest pain for 5 year，aggravating 4 months • Previous LAD PCI 12 months before this re-admission • Smoking and hyperlipidemia for coronary risk factors 12 month FU coronary angiography (2009-7-7)

  3. 12 Mon FU coronary angiography (2009-7-7)

  4. 12 Mon FU coronary angiography (2009-7-7)

  5. Index angioplasty(2008-7-8)

  6. Index angioplasty (2008-7-8)

  7. Index angioplasty(2008-7-8) Final angiographic findings

  8. Lad-LM IVUS imaging

  9. Proximal part of LM stent Ostial LAD Middle LM Distal LM stent Lad-LM IVUS imaging Proximal LM

  10. 12 Mon FU coronary angiography (2009-7-7) After balloon dilatin, I performed IVUS for ostial LCX lesion

  11. Lcx-LM IVUS imaging

  12. What & Why happened at LMCA bifurcation location during Index PCI procedure?

  13. Index angioplasty(2008-7-8) Crosswire NT guidewire 2.5*20mm Ryujin balloon

  14. Index angioplasty(2008-7-8) Partner 2.5*36mm

  15. Index angioplasty(2008-7-8) Partner 3.0*24mm Partner 3.5*24mm --- 14atm

  16. Index angioplasty(2008-7-8) Kongon 3.5*15 in LAD Ryujin 2.5*20mm in LCX After stent cross-over LCX

  17. Index angioplasty(2008-7-8) After Kissing balloon dilation

  18. Index angioplasty(2008-7-8) Maverick 3.0*15mm

  19. Index angioplasty(2008-7-8) Final angiographic findings

  20. What happened at LMCA bifurcation?

  21. And how to treat this one to get optimal result?

  22. 12 Mon FU coronary angiography (2009-7-7) Excel 3.5*18mm—18atm

  23. 12 Mon FU coronary angiography (2009-7-7)

  24. 12 Mon FU coronary angiography (2009-7-7) Apex 3.0*15 mm in LAD at 10atm Stent balloon in LCX at 12atm

  25. 12 Mon FU coronary angiography (2009-7-7)

  26. 12 Mon FU coronary angiography (2009-7-7) Final angio findings

  27. Final angio and IVUS findings

  28. Questions?? • Which step maybe is wrong in this case? • How often does it happen? • How to avoid it during procedure? • Angiography is blind on this complication?

  29. Thanks!

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