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Chest Pain


Case 2 – LAD PCI

Case Presentation

  • A 90-year-old male presented with angina pectoris and dyspnea on exertion.
  • Cardiac CTA revealed 50-70% LAD stenosis distal to the stent.
  • Medical History: Severe aortic stenosis s/p TAVR(CoreValve 31mm) on 9/23/14, CAD (s/p DES to mid and prox LAD on 8/18/14), Lymphoma, and Autoimmune disease (on prednisone).
Coronary angiogram was performed by using JL4/JR4 without any difficulty. It showed 50-60% in mLAD, and multiple discrete lesions in mid RCA.
IVUS of LAD showed MLA of 3.5 mm.2 Given the proper engagement of left coronary system with JL4, we used VL 3.5 for PCI and DES (Xience) 3/12 was placed with good result.

Learning Points

  • JL4/JR4 can also be used in CoreValve cases for selective engagement.
  • If there is a good catheter engagement with diagnostic JL4 catheter, we could use VL 3.5 guide catheter for left coronary artery intervention.

Left Main DK Crush Video ID