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CASE20191101_005
| CORONARY - Bifurcation/Left Main Diseases and Intervention | |
| Left Main & Left Anterior Descending / Diagonal Bifurcation Lesion: What Should Be the Strategy? | |
| Md Shamsul Alam1 | |
| Evercare Hospital Dhaka, Bangladesh1, | |
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[Clinical Information]
- Patient initials or identifier number:
Mr M.S.I
-Relevant clinical history and physical exam:
This Bangladeshi gentleman got admitted with the primary aim to undergo CAG to evaluate his coronary artery status who has been complaining of exertional chest pain. He is a known case of Old Inferior MI & S/P PCI to RCA & LCX.
 Mr M.S.I(1).avi Mr M.S.I(2).avi RUN2.wmv-Relevant test results prior to catheterization:
Haemoglobin: 12.7 gm/dLCreatinine-serum: 0.92 mg/dLEcho: RWMA (+), LVEF: 35-40%
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
LCA was engaged with the guiding catheter XB-3.5(7F). LAD lesion was crossed with Sion blue wire, another wire was kept in DG1 and Pre dilatation was done with 2.0x15mm balloon at 8-14 atm. LM-LAD lesion was stented with a 3.0x40 mm DES at 12-14 atm. Post dilatation was done 4.0x10 mm balloon at 14-18 atm. POT was done also. Final angiogram showed LAD was well dilated with TIMI-III distal flow. After stenting in LM-LAD, IVUS study was done which showed stent is well apposed with clear bifurcation areas.
Mr M.S.I(1).avi Mr M.S.I(2).avi RUN2.wmv- Case Summary:
. Clinical decision is to be determined to be approached using a single stent strategy. . Side Branch stented only if clinical symptoms and/or angiographic or adjunctive feature warrant intervention.. IVUS is a must for LM-LAD stenting.
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