PMC5937515_01
SA angiogram showing diffuse, severe atherosclerosis of the SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.
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fig1
Cardiac catheterization revealed a patent sequential SVG and severe disease of the body of the SA, distal to the left vertebral artery, and involving the LIMA (Figure 1).
Retrograde wiring of the SA via the left radial artery and anterograde wiring of the LIMA via the left femoral artery. SA, subclavian artery; LIMA, left internal mammary artery.
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fig2
Terumo Runthrough NS Hypercoat coronary guidewire was placed from the LFA into the LIMA (Figure 2). The SA was predilated via the LRA.
SA stented, trapping the LIMA wire. Persistent significant disease is noted in the proximal LIMA. SA, subclavian artery; LIMA, left internal mammary artery.
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fig3
A 5 mm x 28 mm balloon expandable stent (Multi-Link Ultra, Abbott Vascular) was then placed into the SA crossing the ostium of the LIMA, trapping the LIMA guidewire (Figure 3).
The DES is deployed in the LIMA with a balloon placed in the SA. The balloon will be inflated following stent deployment prior to concluding with final kissing angioplasty. DES, drug-eluting stent; LIMA, left internal mammary artery; SA, subclavian artery.
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fig4
Abbott Vascular) was easily passed through. A 5 mm x 15 mm noncompliant balloon (NC Trek, Abbott Vascular) was then placed into the SA stent via the LFA, and a small portion of the LIMA stent was pulled back into the SA stent in order to perform "T and small Protrusion" or TAP stenting of the SA/LIMA bifurcation (Figure 4). A final kissing balloon angioplasty was accomplished, and post-op angiography demonstrated a patent SA/LIMA bifurcation (Figure 5).
Final angiogram demonstrating a patent SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.
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fig5
Abbott Vascular) was easily passed through. A 5 mm x 15 mm noncompliant balloon (NC Trek, Abbott Vascular) was then placed into the SA stent via the LFA, and a small portion of the LIMA stent was pulled back into the SA stent in order to perform "T and small Protrusion" or TAP stenting of the SA/LIMA bifurcation (Figure 4). A final kissing balloon angioplasty was accomplished, and post-op angiography demonstrated a patent SA/LIMA bifurcation (Figure 5).