CASE HISTORY
- This 75 year old lady presented with Ischaemic Heart Disease
- Her angiogram showed severe Left Main disease
- The attending physician recommended that she undergoes coronary bypass surgery
- After discussion with her and family, they did not want surgery
- She was therefore listed for Left Main stenting
The baseline angiogram
6F JL 4 guide with Runthrough in LAD
Caudal view
The ostium of the Left Main shows severe disease and narrowing
Pre-dilate with balloon
The narrowing in the left main is first dilated with a balloon
Stent placement in Caudal view
3.5 x 22mm stent placed at ostium of LM
Stent deployed
3.5 x 22 Drug eluting stent inflated to 15atm
Post dilatation
4.0 x 8mm non-compliant balloon inflated up to 16atm
Final result – Caudal view
The Left Main is now treated
The aneurysm is partially sealed
Final result – Cranial view
Successful treatment of Left Main stenosis with Drug Eluting Stent
CONCLUSION
- Presently, left main stenting is performed in many centers around the world
- It has very good mid to long term results
- It is a viable alternative to coronary bypass surgery especially when the patient is not a good candidate for open heart operation/li>
- However, since the left main supplies 2/3 of the blood supply to heart, it is potentially a higher risk procedure/li>
- In experienced hands the success rate is high and complication rate is low
- Intra-Vascular Ultrasound should be used during the procedure, this also requires reasonable amount of expertise/li>