CORONARY - Drug-Eluting Balloons
Drug Coated Balloon of Native Ostial Left Anterior Descending
YEE SIN TEY1, Azhari Rosman2
NATIONAL HEART INSITUTE, Malaysia1, National Heart Institute, Malaysia2,
67-year-old gentleman had dyslipidaemia and coronary artery disease with angioplasty to proximal left anterior descending (LAD) and mid left circumflex (LCX) with drug eluting stent respectively in 2009. He complained of recurrent stable angina at CCS class III for 3 months. he was admitted from clinic and invasive angiogram was scheduled. clinical examination was unremarkable.
Full blood count, renal function and cardiac enzymes were within normal range.
Left Main - mild disease at distal.
Intermediate artery - Normal
Left Anterior Descending - severe ostial LAD stenosis. Stent from proximal-mid LAD with severe in-stent restenosis within.
Left Circumflex - stent at mid segment. mild instent restenosis.
Right Coronary Artery - Dominant artery. Severe stenosis at mid segment 2. AP CRA LAD.avi
IVUS guided coronary angioplasty was performed with right radial approach with guiding catheter EBU 3.5/6Fr and workhorse wire Runthough Floppy. Ostial and ISR lesion were predilated with Minitrek 2.0/15mm and subsequently IVUS was performed. LM was in size of 4.5-4.75mm with ostial proximal LAD at 3.5mm. There was circumferential calcification at the ostial LAD with stent free area of 4mm from ostial LAD to proximal segment of stent edge.
Ostial LAD and ISR lesion were prepared with Cutting Balloon Wolverine 3.0/15mm at 12 atm. Repeated IVUS showed MLA area of 6.12mm2
with the cracked of calcium. There was the absence of dissection at ostial LAD.
Drug coated balloon 2.75/12mm was delivered at mid segment of stent followed by Drug coated balloon 3.0/12 at distal LM to proximal LAD at 6 atm.
His symptom improved significantly. Stage procedure to right coronary artery was performed one week later.
Drug coated balloon showed no inferiority compared to drug eluting stent in de novo lesion of large vessel as well as ostium of side branch. Provisional stenting of distal left main was recommended with bailout stenting of circumflex or intermediate artery if there were significant occlusion of these vessel due to plaque shift or dissection. Careful preparation of calcified lesion at ostial LAD with cutting balloon followed by DCB was an alternative option,