Case Report Form • Title: A case of coronary intervention for left

Case Report Form
• Title: A case of coronary intervention for left main disease by using transradial approach
• Operator: Junghan Yoon
• Institution: Yonsei University Wonju College of Medicine Wonju, KOREA.
• E-mail:
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• Summary of clinical presentation:
A 61 year-old female patient was admitted due to effort angina since 6 months ago. She has a history of
coronary artery bypass graft surgery (LIMA to D1 br., LIMA to RA to 2 nd OM br. And RIMA to RA to rPD br.)
due to three vessels and left main disease at 2006. She has a medication for hypertension and hyperlipidemia
since then. Initial EKG showed normal sinus rhythm without evidence of ischemia. Exercise test showed
negative findings. Echocardiography showed no regional wall motion abnormality and relaxation abnormality
but CT cardiac angiography showed obstruction of graft to LAD. With the diagnosis of stable angina, CCS 2,
coronary angiography was performed.
• Procedural steps:
4Fr. AL1 and 5Fr. JR 4.0 guiding catheter was engaged to left and right coronary artery, respectively. There
were severe stenosis at left main ostium(80% diameter stenosis, DS), 70%DS at LCX ostium, 60%DS at LAD
ostium and diffuse irregular 50% to 70%DS from mid to distal RCA (Fig. 1). For evaluation of RIMA to radial
artery graft to RCA and LIMA to radial artery to OM branch, 5Fr. JR 3.5 and 5Fr. SIM2 guiding catheter were
used. Both angiography showed intact graft patency but there was no visible diagonal branch graft(Fig. 2). To
intervention for left main lesion, 6Fr. JL 3.0 guiding catheter was engaged to left coronary artery. Two 0.014”
Runthrough guiding catheter (Terumo, Japan) were located at the LAD and LCX. To measure of luminal
diameter and lesion length, IVUS was performed. Balloon, NERO 3.0mm/15mm was inflated at the pLAD to
left main ostium with 16 atm. Drug eluting stent, XIENCE V 3.5mm/23mm was deployed at the pLAD to left
main ostium with 20 atm(Fig. 3). It was impossible to pass the 3.0mm/15mm balloon to LCX ostium, so balloon
IKAZUCHI 1.5mm/15mm was inflated at the LCX ostium. But it is also impossible to pass the balloon
IKAZUCHI 3.0mm/15mm to LCX ostium. For increasing the backup support, guiding catheter was change to
6Fr. XB 3.0 and guide wire also changed to FIELDER for LCX. After inflating with balloon RYUJIN
1.5mm/15mm at LCX ostium with 12 atm, kissing balloon NERO 3.0mm/15mm at LAD ostium and RYUJIN
2.5mm/15mm at LCX ostium were inflated with 20 and 15 atm., respectively. Drug eluting stent, XIENCE V
3.0mm/12mm was deployed at the LCX ostium with 9 atm. Provisional T stenting was used(Fig. 4).
• Figures or Tables:
(Figure. 1)
• Take home message: