PMC7990558_01
(a) Medina 0,1,1 disease. (b) Significant disease in proximal-mid LAD. (c) RCA proximal-mid disease. (d) Ostial LCX stent. (e) Sepal wire technique for ostial LMCA stent. (f) CLEARstent image of LAD stent. (g) FKBI (h) POT. (i) CLEARstent of bifurcation. (j) IVUS evaluation of RCA disease. (k) Ostial RCA stent.
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fig1
Coronary angiography revealed critical three-vessel disease involving the ostium of the left anterior descending (LAD), left circumflex (LCX) arteries (medina 0,1,1), and proximal right coronary artery (RCA; Figure 1). When the guide catheter is maximally advanced with the secondary guidewire in the aorta, it stops exactly at the ostium of the coronary artery (as further advancement is prevented by the guidewire which is floating in the aorta) (Figure 1(e)). Bifurcation PCI was completed by redoing FKBI, followed by a POT (Figure 1).
(a) Pre-poststenting images of LMCA. (b) Proximal LAD pre-poststenting. (c) Distal landing zone and stent edge.
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fig2
Distal landing zones and measurements were obtained from the IVUS runs from LCX and LAD to LMCA (Figures 2 and 3(a)-3(c)).
(a) Distal LMCA IVUS. (b) Significant disease at LCX ostium. (c) Distal landing zone in major OM. (d) IVUS image in LCX for assessing stent length. (e) IVUS in LM-LAD to decide proximal and distal stent lengths.
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fig3
Distal landing zones and measurements were obtained from the IVUS runs from LCX and LAD to LMCA (Figures 2 and 3(a)-3(c)). The LMCA-LAD stent chosen was a 4 x 16 mm DES, as the LAD vessel diameter was 4 mm up to the first diagonal branch, and the length from the LMCA ostium to the diagonal was 14.5 mm (Figures 3(d) and 3(e)).