CASE20250819_004
A Challenging Case Report: Left Main Bifurcation Stenting
By Chun Hin Chan
Presenter
Chun Hin Chan
Authors
Chun Hin Chan1
Affiliation
North District Hospital, Hong Kong, China1
View Study Report
CASE20250819_004
Complex PCI - Left Main
A Challenging Case Report: Left Main Bifurcation Stenting
Chun Hin Chan1
North District Hospital, Hong Kong, China1
Clinical Information
Relevant Clinical History and Physical Exam
Past Medical History:- Anterior MI/APO with LVEF 35% akinetic LAD territory in Echocardiogram and pLAD occasion with PTCS done in 2018- DM/HT/COPD----------------attend left chest discomfort and SOBEcho showed global LV impairment and LVEF 18% Simpson, no pericardial effusionCTS suggested limited benefit from CABGdecided for multivessel PCI
Relevant Test Results Prior to Catheterization
TnI 54.8<-- 59.1CK 84<- 87ECG SR, Q wave over V1-V3
Relevant Catheterization Findings
Right dominant Left Main: oLMS 10% dLMS calcified eccentric plaque 80%LAD: oLAD calcified 70%, pLAD 70%, p-mLAD 20% ISRLCX: oLCx calcified 90%, pLCX 80%, m-dLCX 40%RCA:: Anomalous RCA with anterior and inferior takeoff, pRCA 50%, mRCA 50%, dRCA 70%
Impella CP implantedPCI to LM+ LAD+LCX with EBU 3.5 7Fr guiding m shockwave IVL to LM-pLCX, PTCS to oLCX with Onyx 3.5 x 30, LCX stent crushed with NC 3.5 SapphirePTCS LM-pLAD with XIence Skypoint, LM POT with with NE Euphoria 4.5 x 8
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Impella CP implantedPCI to LM+ LAD+LCX with EBU 3.5 7Fr guiding m shockwave IVL to LM-pLCX, PTCS to oLCX with Onyx 3.5 x 30, LCX stent crushed with NC 3.5 SapphirePTCS LM-pLAD with XIence Skypoint, LM POT with with NE Euphoria 4.5 x 8
18.mov 24.mov 30.movInterventional Management
Procedural Step
RFA puncture under USG guidance and Fluoroscopic guidance with micropuncture set, angiogram confirmed CFA puncture above bifurcation6Fr stealth inserted then Preclose x 2, , Exchange to Impella Sheath, Impella CP implanted
PCI to LM+ LAD+LCX with EBU 3.5 7Fr guiding catheter, Ruthrough EF to LAD and LCX, IVUS done, POBA pLCX 3.0 x 10 NC Scoreflex, Wolverine cutting 2.5 x 6 then 3. x 10 up to 12atm, unable to deliver stent with Granslam wire support, decided for shockwave IVL 3.0 and 3.5 to LM- pLCX, further POBA with NC Sapphire 3.5 x 12PTCS to oLCX Onyx 3.5 x 30 and post dilated with stent balloon, LCX stent crush with NC 3.5 Sapphire
LAD POBA with NC Sapphire 3.5 x 12, then PTCS LM-pLAD with Xience Skypoint 3.5 x 33LM POT with NC Euphoria 4.5 x 8, LAD stent post dilated with NC 3.5 x 12Rewiring to LCX with Sion Blue, open with 2.5 x 15 Sapphire II Pro, then NC Sapphire 3.0 x 12 and 3.5 x 12Kissing LAD/LCX NC 3.5 x 12/NC 3.5 x 12Final POT with NC Euphoria 4.5 x 8, good angiographic and IVUS resultRCA engaged with JR4 guiding 6Fr, Runthrough EF to PL, DEB to dRCA/PL with Magictouch 1.5 x 20 with Telescope support, good angiographic resultwound closed with 2 Proglide
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PCI to LM+ LAD+LCX with EBU 3.5 7Fr guiding catheter, Ruthrough EF to LAD and LCX, IVUS done, POBA pLCX 3.0 x 10 NC Scoreflex, Wolverine cutting 2.5 x 6 then 3. x 10 up to 12atm, unable to deliver stent with Granslam wire support, decided for shockwave IVL 3.0 and 3.5 to LM- pLCX, further POBA with NC Sapphire 3.5 x 12PTCS to oLCX Onyx 3.5 x 30 and post dilated with stent balloon, LCX stent crush with NC 3.5 Sapphire
LAD POBA with NC Sapphire 3.5 x 12, then PTCS LM-pLAD with Xience Skypoint 3.5 x 33LM POT with NC Euphoria 4.5 x 8, LAD stent post dilated with NC 3.5 x 12Rewiring to LCX with Sion Blue, open with 2.5 x 15 Sapphire II Pro, then NC Sapphire 3.0 x 12 and 3.5 x 12Kissing LAD/LCX NC 3.5 x 12/NC 3.5 x 12Final POT with NC Euphoria 4.5 x 8, good angiographic and IVUS resultRCA engaged with JR4 guiding 6Fr, Runthrough EF to PL, DEB to dRCA/PL with Magictouch 1.5 x 20 with Telescope support, good angiographic resultwound closed with 2 Proglide
1.mov 2.mov 6.movCase Summary
It is a successful left main bifurcation stenting in patient with severely impaired left ventricular systolic function with Impella CP support, uneventful. It also involved the use of Shockwave for calcified lesion.