A 0.014-inch guide wire was advanced into the LAD in order to stabilize the diagnostic catheter.įigure 2 shows the results of the PCI performed on this patient. We failed to engage the anomalous orifice of the coronary trunk by using a 6-Fr AL-1 guiding catheter (Boston Scientific, MN, USA). Therefore, we utilized a 5-Fr diagnostic AL-1 catheter to engage the coronary trunk and a 0.014-inch floppy guide wire (Sion blue®, Asahi Intecc, Aichi, Japan) was advanced into the distal portion of the LAD ( Figure 2(a)). After extending the guide wire, we removed the diagnostic catheter and left only the guide wire ( Figure 2(b)). A 1.5 mm semicompliance balloon in the lead, along with a mother-child system, including a 6-Fr AL-1 guide catheter and a GuideLiner catheter, was advanced close to the orifice of the coronary trunk ( Figure 2(c)). Then, the GuideLiner catheter was selectively inserted into the left coronary artery by anchoring it coaxially with the 1.5 mm balloon ( Figure 2(d)). In order to avoid coronary dissection, contrast medium was gently injected using a manual method.After dilatation with a 2.5 mm semicompliance balloon ( Figure 2(e)), we have implanted the bioresorbable polymer sirolimus-eluting stent (Ultimaster 3.0 ∗38 mm, TERUMO, Tokyo, Japan) under the intravascular ultrasound guide ( Figure 2(f)). The stent was additionally dilated with a noncompliance balloon 3.5 ∗12 mm ( Figure 2(g)). A final angiogram showed adequate and favorable dilatation of the culprit lesion ( Figure 2(g)). (a) We failed to engage the coronary trunk by using a 6-Fr AL-1 guiding catheter.ĭuring the procedure, the volume of contrast medium used was 75 mL, and the radiation exposure dose was 0.78 Gy. We then engaged the coronary trunk by using a 5-Fr diagnostic catheter, and a 0.014-inch guide wire was advanced across the LAD lesion. (b) Removing the 5-Fr diagnostic catheter, leaving only the guide wire. (c) A 1.5 mm semicompliance balloon in the lead, along with a mother-child system, including a 6-Fr AL-1 guide catheter and a GuideLiner catheter, was advanced close to the orifice of the coronary trunk. (d) After anchoring it with a 1.5 mm balloon, the GuideLiner catheter was selectively introduced into the left coronary artery. In order to avoid coronary dissection, the contrast medium was gently introduced via manual injection. (e) Angiogram after dilatation with a 2.5 mm semicompliance balloon. Intravascular ultrasound (IVUS) images at the culprit lesion (i) and at the coronary ostium (ii). (f) Deploying a bioresorbable polymer sirolimus-eluting stent (Ultimaster® 3.0 ∗38 mm).
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