IVUS evaluation TAP technology for unprotected left main bifurcation lesions interventional therapy

Yong-Sheng Ke. MDDepartment of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001

Brief history

Male, 66yaer old, Spontaneous chest pain 2 days Past medical history: no hypertension no DM no lipid abnormal Smoking history:20 yrs, 20 cigarettes/d

ECG after first chest pain attack

ECG after 3 days

Biochemistry examination

cTnI

Admission diagnosis

Coronary heart disease Acute coronary syndrome

CAG

Syntax score 39

LM 5*2=10Bifurcation=1

Calcification=2

13

LCX 1.5*2=3Bifurcation 1

Calcification 2Long lesion 1

7

pLAD 3.5*2=7Bifurcation 1

Calcification 2Long lesion 1

11

mLAD 2.5*2=5D1 1D2 1

Long lesion 18

7F JL3.5 Runthrough BMW

Maverick-2 2.0*15mm 12-14atm

IVUS

LAD-LM LCX-LM

ostial lesion of LM ostial lesion of LAD

ostial lesion of LCX middle lesion of LCX

mLAD

Resolute 3.5*30mm 12atm

Stent balloon 14atmResolute 4.0*24mm

16atm Exchange guide wire LM-LCX Maverick-2 2.0*15mm LM-LAD Quantum 3.5*12mm

LM-LCX 16atmLM-LAD 18atm

Kissing balloon dilatation 12atm

LM-LAD Quantum 3.5*12mmLM-LCX Resolute 2.75*30mm

LCX stent 12atm

Retracement of the stent balloon 14atm Kissing balloon dilatation

LCX-LM Quantum 3.0*12mm16-18atm

Non-compliant balloon dilatation（ 18atm,respectively)

Final kissing dilatation 12atm

LAD-LM LCX-LM

mLAD

Two stents no overlap regionBut, no dissection

Two layer stents

Ostial of LM

Ostial of LCX

Distal LM-ostial LAD

ECG after PCI

Myocardial enzymes after PCI

ECG after 1 month

ECG after 2 month

Discuss IVUS is helpful for judgment Lesion and

guidance of stent implantation. Two stents of the left anterior descending

artery were not completely overlap （ 2mm gap ） .

IVUS had not found intimal dissection of stents exposed area,lumen diameter was large enough, we didn't need immediatly suppling a stent, waiting for further follow-up.