case_images: PMC5937515_01
case_images: SA angiogram showing diffuse, severe atherosclerosis of the SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.
case_images: CRIC2018-9340183.001.jpg
case_images: PMC5937515_01_CRIC2018-9340183.001.jpg
case_images: fig1
case_images: Cardiac catheterization revealed a patent sequential SVG and severe disease of the body of the SA, distal to the left vertebral artery, and involving the LIMA (Figure 1).
case_images: Retrograde wiring of the SA via the left radial artery and anterograde wiring of the LIMA via the left femoral artery. SA, subclavian artery; LIMA, left internal mammary artery.
case_images: CRIC2018-9340183.002.jpg
case_images: PMC5937515_01_CRIC2018-9340183.002.jpg
case_images: fig2
case_images: Terumo Runthrough NS Hypercoat coronary guidewire was placed from the LFA into the LIMA (Figure 2). The SA was predilated via the LRA.
case_images: SA stented, trapping the LIMA wire. Persistent significant disease is noted in the proximal LIMA. SA, subclavian artery; LIMA, left internal mammary artery.
case_images: CRIC2018-9340183.003.jpg
case_images: PMC5937515_01_CRIC2018-9340183.003.jpg
case_images: fig3
case_images: A 5 mm x 28 mm balloon expandable stent (Multi-Link Ultra, Abbott Vascular) was then placed into the SA crossing the ostium of the LIMA, trapping the LIMA guidewire (Figure 3).
case_images: The DES is deployed in the LIMA with a balloon placed in the SA. The balloon will be inflated following stent deployment prior to concluding with final kissing angioplasty. DES, drug-eluting stent; LIMA, left internal mammary artery; SA, subclavian artery.
case_images: CRIC2018-9340183.004.jpg
case_images: PMC5937515_01_CRIC2018-9340183.004.jpg
case_images: fig4
case_images: Abbott Vascular) was easily passed through. A 5 mm x 15 mm noncompliant balloon (NC Trek, Abbott Vascular) was then placed into the SA stent via the LFA, and a small portion of the LIMA stent was pulled back into the SA stent in order to perform "T and small Protrusion" or TAP stenting of the SA/LIMA bifurcation (Figure 4). A final kissing balloon angioplasty was accomplished, and post-op angiography demonstrated a patent SA/LIMA bifurcation (Figure 5).
case_images: Final angiogram demonstrating a patent SA/LIMA bifurcation. SA, subclavian artery; LIMA, left internal mammary artery.
case_images: CRIC2018-9340183.005.jpg
case_images: PMC5937515_01_CRIC2018-9340183.005.jpg
case_images: fig5
case_images: Abbott Vascular) was easily passed through. A 5 mm x 15 mm noncompliant balloon (NC Trek, Abbott Vascular) was then placed into the SA stent via the LFA, and a small portion of the LIMA stent was pulled back into the SA stent in order to perform "T and small Protrusion" or TAP stenting of the SA/LIMA bifurcation (Figure 4). A final kissing balloon angioplasty was accomplished, and post-op angiography demonstrated a patent SA/LIMA bifurcation (Figure 5).