Clinical Case : Significant LM Diameter Mismatch Treated with IVUS-guidance
Bill Gogas, Fei Ye (syndicatedfeeds)
LTRA 6F JL4 GC w/ Seldinger technique.
Buddy wire technique to cross angulated ostium of LAD w/ Runthrough NS.
Following distal placement of BMW wire, Runtrhough NS was retrieved.
Sequential balloon dilatations w/ 2,5 NC Sprinter Legend from distal to proximal with increasing atmospheres from 10 to 18 was performed. IVUS indicated distal LAD w/ RVD of at least 2,5 mm and proximal LAD media to media diameter of 3,5 mm suggested by IVUS (BS, US) which equals (3,5 mm - 0,25 mm) to vessel diameter of 3,25 mm.
Distal LM PB: 45-50% while proximal LM: >55%.
Distal LAD was treated w/ a 2,5 x 35 DES and mid- to prox-LAD up to distal LM with 3.0 x 28 mm DES*.
*DES of 3.0 or 3.5 mm can be post-dilated up to 4.25 mm
Proximal LAD was post-dilated with 3.0 NC Sprinter balloon to reach expansion of 3,5 mm and LM was post-dilated with 4.0 NC balloon to reach diameter of 4.5 mm.
IVUS confirmed MSAs: LM > 11mm2 & LAD > 7 mm2.
Good angiographic result confirmed by IVUS optimal geometric indices post-stent deployments.
Case Presenter Bill Gogas, Interventional
Cardiologist, Visiting Professor of Medicine (Cardiology) at Nanjing First Hospital, China
Case Performed in The Spencer B. King III Catheterization Laboratory
Mentors Spencer B. King III, Shao-liang Chen
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