IMAGE-GUIDED LEFT MAIN BIFURCATION PCI USING TAP TECHNIQUE
Researchers & Contributors
Dr. Ritwik Ghosal
MBBS (Hons) MD DNB (Medicine) MRCP (UK) DM (Cardiology)
Consultant and Interventional Cardiologist
Department of Cardiology
Woodlands Multispeciality Hospital
Kolkata, West Bengal, India
Case Videos
Video 1
PATIENT PARTICULARS: 75 Yrs old hypertensive non diabetic male with h/o COPD presented with complaints of rest angina for 1 week. Previous h/o PTCA to LCX as primary PCI 1yr back and PTCA to LAD as staged procedure in another hospital. ECG- T wave inversion in inferior and lateral precordial leads. Echo- no RWMA with LVEF- 64%. CAG- LMCA- distal part significant disease which continued as ostioproximal significant disease in LAD & LCX Medina (1,1,1), previous stents are patent with minor late loss, RCA - dominant normal. Patient was given option of CABG which they strongly denied and opted for LM Bifurcation PCI.
Video 2a
Our plan was to perform image guided Left Main Bifurcation PCI with TAP technique to keep the procedure as simple as possible. So femoral access taken and 7 Fr EBU 3.5 GC engaged , wired both vessels could not predilate the lesion with a 2.0 mm sc balloon so created passage with 1.25mm sc balloon.
Video 2b
Our plan was to perform image guided Left Main Bifurcation PCI with TAP technique to keep the procedure as simple as possible. So femoral access taken and 7 Fr EBU 3.5 GC engaged , wired both vessels could not predilate the lesion with a 2.0 mm sc balloon so created passage with 1.25mm sc balloon.
Video 2c
Our plan was to perform image guided Left Main Bifurcation PCI with TAP technique to keep the procedure as simple as possible. So femoral access taken and 7 Fr EBU 3.5 GC engaged , wired both vessels could not predilate the lesion with a 2.0 mm sc balloon so created passage with 1.25mm sc balloon.
Video 3a
After creating the passage with smaller balloon both ostial lesion was further predilated with 2.0x10mm sc and 2.5x12 mm nc balloon at 18-20 atm.
Video 3b
After creating the passage with smaller balloon both ostial lesion was further predilated with 2.0x10mm sc and 2.5x12 mm nc balloon at 18-20 atm.
Video 3c
After creating the passage with smaller balloon both ostial lesion was further predilated with 2.0x10mm sc and 2.5x12 mm nc balloon at 18-20 atm.
Video 4
After predilating the lesion OCT run was taken in LAD which reveals underexpansion of the previous stent with neointimal proliferation, fibrocalcific disease in proximal LAD and dissection with white thrombi in distal LMCA and proximal LAD. Vessel size estimated and landing zone in the shaft of LMCA was demarcated. Looking at the amount of calcification and neointimal proliferation 2.75 x 12 mm cutting balloon was used.
Video 5
OCT run taken from LCX to LM which suggested well expanded pevious stent with exact size and length of stent requirement and landing zone determined.
Video 6
OCT run taken from LCX to LM which suggested well expanded pevious stent with exact size and length of stent requirement and landing zone determined.
Video 7a
3.5x33 mm DES deployed from LAD to mid shaft of LM at 12 atm overlapping with previous LAD stent. Adequately post dilated whole stent with 3.5x12mm NC balloon from 12-20 atm and POT done using 4.0x6mm NC balloon at 12 atm. Then recrossing was done with sion blue wire from the distal strut which was then confirmed with the help of OCT run.
Video 7b
3.5x33 mm DES deployed from LAD to mid shaft of LM at 12 atm overlapping with previous LAD stent. Adequately post dilated whole stent with 3.5x12mm NC balloon from 12-20 atm and POT done using 4.0x6mm NC balloon at 12 atm. Then recrossing was done with sion blue wire from the distal strut which was then confirmed with the help of OCT run.
Video 7c
3.5x33 mm DES deployed from LAD to mid shaft of LM at 12 atm overlapping with previous LAD stent. Adequately post dilated whole stent with 3.5x12mm NC balloon from 12-20 atm and POT done using 4.0x6mm NC balloon at 12 atm. Then recrossing was done with sion blue wire from the distal strut which was then confirmed with the help of OCT run.
Video 8a
Strut dilation done with 1.25mm SC balloon. 3.5x12mm NC balloon kept in LAD and 3.0x13mm DES deployed at 12 atm. Kissing balloon inflation(KBI) done with 3.5x12mm NC in LAD and 3.0x12mm NC in LCX inflating both at 12 atm then gradually deflation of LAD ballon first and then LCX balloon. Final POT done with 4.0x6 mm NC balloon at 12 atm.
Video 8b
Strut dilation done with 1.25mm SC balloon. 3.5x12mm NC balloon kept in LAD and 3.0x13mm DES deployed at 12 atm. Kissing balloon inflation(KBI) done with 3.5x12mm NC in LAD and 3.0x12mm NC in LCX inflating both at 12 atm then gradually deflation of LAD ballon first and then LCX balloon. Final POT done with 4.0x6 mm NC balloon at 12 atm.
Video 8c
Strut dilation done with 1.25mm SC balloon. 3.5x12mm NC balloon kept in LAD and 3.0x13mm DES deployed at 12 atm. Kissing balloon inflation(KBI) done with 3.5x12mm NC in LAD and 3.0x12mm NC in LCX inflating both at 12 atm then gradually deflation of LAD ballon first and then LCX balloon. Final POT done with 4.0x6 mm NC balloon at 12 atm.
Video 9a
Final OCT run taken which shows well apposed and expanded LAD and LCX stents and ruled out any edge dissection which was a doubt after taking the last angio shot.
Video 9b
Final OCT run taken which shows well apposed and expanded LAD and LCX stents and ruled out any edge dissection which was a doubt after taking the last angio shot.
Video 9c
Final OCT run taken which shows well apposed and expanded LAD and LCX stents and ruled out any edge dissection which was a doubt after taking the last angio shot.