case_images: PMC6351329_01
case_images: (A) Inserted 6 French sheath via left snuffbox approach. (B) Urgent CAG demonstrating the severe stenosis in the left main bifurcation site (arrow, left) and post-PCI CAG demonstrating successful stenting with POT of the left main bifurcation site (right). (C) IVUS imaging demonstrating MLA of 2.3 mm2 and plaque burden of 86.5%. (D, E) Pre-PCI IVUS demonstrating distal and proximal reference vessel diameter of 3.95 mm and 5.45 mm, respectively. (F) Post-PCI IVUS demonstrating MSA of 8.0 mm2. (G) IVUS cross-section demonstrating stent area of 15.7 mm2 and good strut apposition (arrowheads) in the left main bifurcation site (arrow, wire in LCx). (H) Post-PCI IVUS demonstrating DES overexpansion and stent diameter of 4.9 and 5.4 mm at maximal stent area site. CAG: coronary angiography, DES: drug-eluting stent, EES: everolimus-eluting stent, IVUS: intravascular ultrasound, MLA: minimal lumen area, LCx: left circumflex artery, PCI: percutaneous coronary intervention, POT: proximal optimization technique.
case_images: cmj-55-66-g001.jpg
case_images: PMC6351329_01_cmj-55-66-g001.jpg
case_images: F1
case_images: Tokyo, Japan) (Fig. 1A). CAG demonstrated the severe stenosis in the distal left main coronary artery (LMCA) that extended into proximal left anterior descending artery (LAD) (Fig. 1B, left). Therefore, intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) was planned. IVUS showed minimal lumen area of 2.3 mm2 with plaque burden of 86.5%, a proximal and distal reference vessel diameter of 5.45 mm and 3.95 mm, respectively (Fig. 1C-E). Postdilation for proximal optimization technique (POT) was achieved with a 5.0x12 mm non-compliant balloon (NC Emerge , Boston Scientific, Natick, MA, USA) at up to 18 atmospheres and repeated IVUS assessment demonstrated good strut apposition and minimal and maximal stent area of 8.0 mm2 and 20.6 mm2 (stent diameter of 4.9 and 5.4 mm), respectively (Fig. 1F-H). Final CAG showed good distal flow without residual stenosis (Fig. 1B, right).