Challenging LAD Ostial PCI: An Innovative Technique
Simultaneous balloon placement from distal LM to proximal LCX prevented the unwanted stent movement during its placement and also properly guides us for proper precise stent placement at the ostium.
Parked balloon from distal LM to LCX will also be helpful for quick measure for any plug shifting into LCX , in case if it is occurred.
Our technique is quick, effective, and technically simple approach for successful treatment of LAD Ostial lesion. As per our knowledge this technique was not used and reported earlier.
For precise LAD Ostial PCI it is necessary to reiterate that the stent is within the radio-opaque markers on the stent balloon and thus the proximal marker must be positioned proximal to the ostial LAD.
Excessive stent movement during Stent placement may be particularly problematic with ostial LAD stenting, as seen in where oscillation of the LAD stent increases the risk of inaccurate placement.
Techniques to prevent excessive stent movement: Respiratory motion – A breath-hold, gentle shallow breathing. Cardiac motion: Pharmacological methods (such as Esmolol, Adenosine and Atropin), Rapid ventricular pacing and partial pre-inflation technique. Disadvantage: short time window may potential distress the patient can be counterproductive (Euro Intervention 2009;5:1-00). Simultaneous balloon placement is technically simple approach for prevention of unwanted stent movement during stent placement. Operators should also consider: 7 Fr guiding catheter, super zooming, RAD caudal or LAD caudal view, DES stent with High radial force and good visibility of the stent. Our technique is quick, effective, and technically simple approach for precise stent placement at LAD.