PMC3629927_01
Coronary angiogram showing LMCA disease with severe ostial LAD stenosis and moderate proximal circumflex disease.
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In addition, there was a moderate lesion on mid right coronary and severe stenosis on distal right coronary artery (Fig. 1).
A) Subocclusive stenosis at the anastomotic site (showed with dotted arrow); LIMA, left internal mammary artery; LAD, left anterior descending artery. B) a "post-injection" view showing the frame of the 2 stents in the LAD (LAD1: pre-anastomotic; LAD2: post-anastomotic; LAD3: distal part of the stent) and the stent in the Circumflex (Cx1, Cx2), with an obvious "over-stent" subocclusive stenotic anastomosis (dotted arrow).
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Cardiac echogram showed severe left ventricular anterior hypokinesis, ejection fraction at 30%, and emergent coronary angiogram revealed a subocclusive stenosis of the left internal mammary at the anastomotic site (Fig. 2).
PCI of LMCA, proximal LAD and proximal circumflex.
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It consisted of LMCA, proximal LAD, and proximal circumflex angioplasty/stenting (Fig. 3) using T-stenting technique (Everolimus drug eluting stents) with end kissing balloon angioplasty.