CORONARY - Bifurcation/Left Main Diseases and Intervention
We Need to Flare, What's the Problem Then? - When Separate Ostia, Choose the Right Guide
Salma Mohamed E-lshokafy1
Tanta University Hospital, Egypt1,
Nothing remarkable HB 11.5TLC 4800PLATELETS 250000INR 1 S.CREATININE 1.1UREA 40 VIROLOGY NEGATIVE
LM: Very short vessel ( Mostly separate ostia ) LAD: Atherosclerotic diffusely diseased vessel with ostial 90% calcific lesion followed by long mid-segment significant lesion LCX: Atherosclerotic vessel with no significant lesions OM: Atherosclerotic big vessel with mid-segment significant lesion RCA: Atherosclerotic vessel with no significant lesions
Engagement of LM was done with FL 3.5 Guiding catheterWiring of LAD using run-through intermediate guide wirePre-dilatation of mid LAD with balloon 2.5*15 mm followed by stenting with DES 2.75 * 36 mm, then stenting of ostial LAD with another overlapping DES 3.5 * 36 mm after pre-dilatation of the lesion with 2.75*36 mm balloon Wiring of LCX was done before deployment of ostial LAD stent, Then stenting of OM lesion with DES 2.75 * 28 mm after pre-dilatation with 2 * 15 mm semi-complaint balloonFlaring of LAD stent is needed, so re-wiring of LAD then failure of passage of balloon as in spider view we found that the guiding catheter is above the stent so wire goes sub-strut and the balloon was impossible to pass. So, Re-direction and re-engagement of the guiding catheter was done, and re-wiring with lopped wire so the balloon passed easily and flaring was done. separate ostia.pptx
1. Always keep an eye on ostial deployed stents, Good Flaring is a must.2. When failure of balloon passage, Think again and again, your wire may be sub strut.3. The right choice of guiding catheter will ease your procedure.