AsiaIntervention 2017;3:160-161, DOI: 10.4244/AIJ-D-16-00028
An 80-year-old man had culotte stenting performed for a left main (LM) true bifurcation lesion (Panel A). He underwent implantation of a first stent on the LM-left circumflex artery (LCx) with an Ultimaster® 2.5×18 mm (Terumo, Tokyo, Japan). After opening the jailed struts, he underwent a second stent implantation on the LM-left anterior descending artery (LAD) with an Ultimaster 3.0×24 mm. After rewiring to the LCx, using three-dimensional optical coherence tomography (3DOCT) with the OPTIS™ Metallic Stent Optimization Software™ (St. Jude Medical, St. Paul, MN, USA), no links connecting to a carina were confirmed, but the guidewire recrossed to the LCx through some tissue on the LCx ostium, and the distal cell rewiring could not be confirmed (Panel B). and the distal cell rewiring could not be confirmed (Panel B). According to two-dimensional OCT (2D-OCT), the unsuccessful confirmation with 3D-OCT was caused by thrombus formation on the jailed struts, and the guidewire recrossed through the distal cell (Panel C, Moving image 1). After final kissing balloon dilation, coronary angiography (Panel D), 2D-OCT (Moving image 2), and 3D-OCT (Supplementary Figure 1) showed a good result. 3D-OCT is useful for bifurcation PCI, but confirmation by 2D-OCT is also required.
Moving image 1. 2D-OCT from LAD to LM, after second stent implantation followed by rewiring to LCx.
Moving image 2. Final 2D-OCT from LAD to LM.
To download, please click below.