Server Stenosis of LCX Orifice and bad stenting final result : Short Period follow-up(6Ms)

People’s Hospital of Zhengzhou Universty, PR China (河南省人民医院 )

Dr. Chuanyu Gao ( 高传玉 )

Case History

• Male 78 ys

• High Degree AVB with AF and Single Chamber Pacer-Maker implantation

• Unstable Angina Pectoris

• Orifice of LCX : 90% with calcification

RCA basically was normal, LCX orifice was significant stenosis around 90% with very significant calcification and strange plaque surface.

Distal Left Main Was Involved about 50% stenosis.

PCI Treating Design

• Femoral Approach

• 7F Guiding

• Two wires (LAD and LCX)

• Rotablator / cutting balloon if needed

• Cullotte Stenting or Provinsional T stent (lcx)

• IVUS assistant

Femoral approach, 7F JL4 Guiding

BMW wiresX 2, Swapped to Pilot 50 wire in LCX

spended long time for wiring

Difficult to wire LCX

Mini-Trek 2.0x15 Balloon10atmx10sx2 times

Flextome Cutting balloon 2.75X6mmX3 times, 10atmx10s

Images: After Cutting Balloon AND Before Stenting

Images: After Cutting Balloon AND Before Stenting

Mid Lcx Left Main

Abbott Xience V 3.5X23 StentPosition stent from Beginning of LM to LCX

Abbott Xience V 3.5X23 Stent

18 atmx20 s

Contrast : before stenting Stenting …..

Dissection and Residual narrow at Circumflex : Hazy on the top and contrast stain under circumflex

LAD orifice involved and some narrow

Sprinter 2.0x12, 3.5x12 dilated LAD

Sprinter 3.5x12, 3.5x12 dilated LAD with kissing skill

After stenting:

Voyager NC 4.0x12 –post dilatation to LCX and LM

LCX orifice hazing

Dissection worsened?

Stent strut broken?

New thromsosis?

Connecting position Images of Circumflex : stent deformed and heamo

rage under itima?

Question and what we do for the situation

• Implant another stent in circumflex

• Implant second stent in LAD

• T—stent in LAD

• Cullotte stent

• Stop the procedure and strengthen anticoagulation

• Follow-up 6months with non-symptom

Follow-up 6months with non-symptom Lcx-LM

Follow-up 6months with non-symptom:angiogram findings

Follow-up 6months with non-symptom:angiogram findings

Follow-up 6months with non-symptom:angiogram findings

Follow-up 6months with non-symptom:angiogram findings

Follow-up 6months with non-symptom:IVUS findings

Conclusion

• Calcification lesion is very hard sometimes

• Calcification lesion is very difficult to evaluate , judge and manage

• The PCI is very difficult to decide which further skill is fit for him

• Calcification lesion is relatively statble.

• Please give some suggestion and discussion: best way for treatment ?

THANK YOU FOR YOUR GUIDING ANG SUGGESSTION

And for your attention!