Doctor & Patient Education Cardiac Specialist Centre
Intervention
2. A case of Left Main stenting
CASE HISTORY
  • This 75 year old lady presented with Ischaemic Heart Disease
  • Her angiogram showed severe Left Main disease
  • The attending physician recommended that she undergoes coronary bypass surgery
  • After discussion with her and family, they did not want surgery
  • She was therefore listed for Left Main stenting

The baseline angiogram
6F JL 4 guide with Runthrough in LAD


 

Caudal view
The ostium of the Left Main shows severe disease and narrowing


 

Pre-dilate with balloon
The narrowing in the left main is first dilated with a balloon


 

Stent placement in Caudal view
3.5 x 22mm stent placed at ostium of LM


 

Stent deployed
3.5 x 22 Drug eluting stent inflated to 15atm


 

Post dilatation
4.0 x 8mm non-compliant balloon inflated up to 16atm


 

Final result - Caudal view
The Left Main is now treated
The aneurysm is partially sealed


 

Final result – Cranial view
Successful treatment of Left Main stenosis with Drug Eluting Stent


 

CONCLUSION
  • Presently, left main stenting is performed in many centers around the world
  • It has very good mid to long term results
  • It is a viable alternative to coronary bypass surgery especially when the patient is not a good candidate for open heart operation
  • However, since the left main supplies 2/3 of the blood supply to heart, it is potentially a higher risk procedure
  • In experienced hands the success rate is high and complication rate is low
  • Intra-Vascular Ultrasound should be used during the procedure, this also requires reasonable amount of expertise
Consultation
Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.