LEFT MAIN: Short LM, Bifurcates, normal.
LEFT ANTERIOR DESCENDING ARTERY: Type 3 vessel, proximal LAD - normal. Mid LAD shows bifurcation stenosis involving D1 (Medina 1-1-1) with 90% severity. Distal LAD appear free of significant stenosis.
Major diagonal (D1): 90% ostial stenosis. It divides into upper bigger branch and lower smaller branch; upper branch shows 90% stenosis. Distal segments - normal.
LEFT CIRCUMFLEX ARTERY: Non-dominant, LCX and OM branches free of flow limiting stenosis.
RIGHT CORONARY ARTERY: Dominant, ostioproximal RCA - normal. Proximal RCA - 70% stenosis. Mid and distal RCA / PLVB and PDA - normal.
IMPRESSION: DOUBLE + BRANCH VESSEL DISEASE
LMCA was cannulated with JL 3.5 7F and LAD wired with 0.014 x 180 cm Runthrough wire and parked distally in D1. The distal LAD was wired with another Runthrough guidewire. Both vessels were sequentially predilated with 2.0 x 12 mm NC balloon up to 12 atm at lesion segments.
Then Major Diagonal (D1) was stented with 2.5 x 28 mm stent at 12 atm. The diagonal wire was removed and proximal part of diagonal stent was crushed with 2.75 x 12 mm NC balloon up to 20 atm followed by 3.25 x 8 mm NC glide up to 18 atm. Then the LAD segment was stented with Eternia 2.75 x 36 mm deployed at 14 atm.
The LAD stent was post dilated with 2.75 x 12 mm NC balloon up to 20 atm distally followed by 3.25 x 8 mm NC glide upto 18 atm in the proximal segments. The major diagonal was rewired through the struts of LAD stent with Runthrough guidewire. The stent struts were expanded with 2.0 x 10 mm SC balloon.
Check shot showed dissection in proximal edge of D1 with a malapposed area at D1 ostium. The ostial D1 was stented with another balloon 2.25 x 8 mm, deployed at 16 atm. Post dilatation of this stent was done with 2.75 x 12 mm NC balloon up to 20 atm; after rewiring and crushing the proximal part of the ostial D1 stent, SKD was done with 2.75 x 12mm NC balloon in LAD and another 2.75 x 12 mm NC balloon in D1 at 12 atm.
Check angiogram showed dissection of the proximal edge of the LAD stent; which was stented with 3.0 x 15 mm deployed at 12 atm and postdilated with 3.25 x 8 mm NC glide up to 18 atm. Final check angiogram shows good stent apposition, no residual stenosis, no thrombus or dissection, with TIMI III flow in LAD and major diagonal.
RCA cannulated with guiding catheter. The lesion was wired with 0.014 x 180 cm guidewire and parked distally. The lesion was directly stented with 2.75 x 36 mm at 16 atm. The stent was postdilated with NC balloon 3.0 x 18 mm upto 20 atm.
Final check angiogram shows good stent apposition, TIMI III flow, no residual stenosis. Achieving good stent apposition, TIMI III flow, and no residual stenosis helped preserve side branch patency by maintaining flow, avoiding ostial compromise, and reducing long-term restenosis or occlusion risk.