Total occlusion of left anterior descending coronary artery
Still frame from the angio shows total occlusion of left anterior descending coronary artery after a major diagonal branch. LMCA: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery. The marked portion of the catheter is in the descending aorto.
Total occlusion of left anterior descending coronary artery
Total occlusion of left anterior descending coronary artery (angio video) (18 MB)
Balloon inflation in LAD
Guide wire is cautiously passed across the total occlusion taking care that it does not produce a false lumen. If the wire is able to pass back and forth into multiple side branches, we can be sure that the wire is in the true lumen. There should not any dye staining or extravasation with check shots of angio. Balloon is passed over the guide wire and inflated and deflated with the indeflator. Patient status and ST segment on the ECG monitor are watched during inflation, though no change is likely while inflating a non-collateralised total occlusion.
Balloon inflation in LAD video (winrar file) 740 KB
Check angio after balloon dilatation of LAD
Check angiogram after balloon dilatation of LAD shows good flow through out the extend of LAD, also visualising the side branches. Now the vessel is ready for stent insertion after measuring the size of the lesion (length and diameter).
LAD after balloon inflation
LAD after stent insertion and balloon dilatation
The predilatation balloon is removed and the balloon mounted stent is inserted over the guide wire. The stent balloon is inflated to the rated nominal pressure and sometimes even beyond that level, taking care not to exceed the rated burst pressure. Balloon inflation pressure is monitored in pressure guage attached to the indeflator. Check angio after stent expansion shows good TIMI 3 flow and the stented segment stands out as a slight bulge in the vessel profile at the distal end. This is because of the natural tapering of the vessel from the proximal to distal portion of the stent.
LAD after stent insertion
LAD after stent insertion – angio video (winrar file) 4.8 MB