IVUS evaluation TAP technology for unprotected left main bifurcation lesions interventional therapy Yong-Sheng Ke. MD Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui

Brief history  Male, 66yaer old,  Spontaneous chest pain 2 days  Past medical history: no hypertension no DM no lipid abnormal Smoking history:20 yrs, 20 cigarettes/d

ECG after first chest pain attack

ECG after 3 days

Biochemistry examination

cTnI

Admission diagnosis  Coronary heart disease Acute coronary syndrome

CAG

Syntax score 39 LM 5*2=10 Bifurcation=1 Calcification=2 13 LCX 1.5*2=3 Bifurcation 1 Calcification 2 Long lesion 1 7 pLAD 3.5*2=7 Bifurcation 1 Calcification 2 Long lesion 1 11 mLAD 2.5*2=5 D1 1 D2 1 Long lesion 1 8

7F JL3.5 Runthrough BMW

Maverick-2 2.0*15mm 12-14atm

IVUS

LAD-LM LCX-LM

ostial lesion of LM ostial lesion of LAD ostial lesion of LCXmiddle lesion of LCX

mLAD

Resolute 3.5*30mm 12atm

Stent balloon 14atm Resolute 4.0*24mm

16atm Exchange guide wire LM-LCX Maverick-2 2.0*15mm LM-LAD Quantum 3.5*12mm

LM-LCX 16atm LM-LAD 18atm

Kissing balloon dilatation 12atm

LM-LAD Quantum 3.5*12mm LM-LCX Resolute 2.75*30mm

LCX stent 12atm

Retracement of the stent balloon 14atm Kissing balloon dilatation

LCX-LM Quantum 3.0*12mm 16-18atm

Non-compliant balloon dilatation （ 18atm,respectively)

Final kissing dilatation 12atm

LAD-LM LCX-LM

mLAD Two stents no overlap region But, no dissection

Two layer stents Ostial of LM Ostial of LCX Distal LM-ostial LAD

ECG after PCI

Myocardial enzymes after PCI

ECG after 1 month

ECG after 2 month

Discuss  IVUS is helpful for judgment Lesion and guidance of stent implantation.  Two stents of the left anterior descending artery were not completely overlap （ 2mm gap ）.  IVUS had not found intimal dissection of stents exposed area,lumen diameter was large enough, we didn't need immediatly suppling a stent, waiting for further follow-up.