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IVUS evaluation TAP technology for unprotected left main bifurcation lesions interventional therapy
Yong-Sheng Ke. MDDepartment of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001
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Brief history
Male, 66yaer old, Spontaneous chest pain 2 days Past medical history: no hypertension no DM no lipid abnormal Smoking history:20 yrs, 20 cigarettes/d
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ECG after first chest pain attack
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Biochemistry examination
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Admission diagnosis
Coronary heart disease Acute coronary syndrome
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Syntax score 39
LM 5*2=10Bifurcation=1
Calcification=2
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LCX 1.5*2=3Bifurcation 1
Calcification 2Long lesion 1
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pLAD 3.5*2=7Bifurcation 1
Calcification 2Long lesion 1
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mLAD 2.5*2=5D1 1D2 1
Long lesion 18
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7F JL3.5 Runthrough BMW
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Maverick-2 2.0*15mm 12-14atm
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ostial lesion of LM ostial lesion of LAD
ostial lesion of LCX middle lesion of LCX
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Resolute 3.5*30mm 12atm
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Stent balloon 14atmResolute 4.0*24mm
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16atm Exchange guide wire LM-LCX Maverick-2 2.0*15mm LM-LAD Quantum 3.5*12mm
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LM-LCX 16atmLM-LAD 18atm
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Kissing balloon dilatation 12atm
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LM-LAD Quantum 3.5*12mmLM-LCX Resolute 2.75*30mm
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Retracement of the stent balloon 14atm Kissing balloon dilatation
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LCX-LM Quantum 3.0*12mm16-18atm
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Non-compliant balloon dilatation( 18atm,respectively)
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Final kissing dilatation 12atm
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mLAD
Two stents no overlap regionBut, no dissection
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Two layer stents
Ostial of LM
Ostial of LCX
Distal LM-ostial LAD
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Myocardial enzymes after PCI
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ECG after 1 month
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ECG after 2 month
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Discuss IVUS is helpful for judgment Lesion and
guidance of stent implantation. Two stents of the left anterior descending
artery were not completely overlap ( 2mm gap ) .
IVUS had not found intimal dissection of stents exposed area,lumen diameter was large enough, we didn't need immediatly suppling a stent, waiting for further follow-up.