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Abstract

Submit Manuscript | http://medcraveonline.com plaque, that was located in the distal segment of the LMCA ( Figure 1). There were also other lesions, a thrombotic total occlusion of the proximal circumflex (CX) artery and a severe stenosis of the proximal left anterior descending (LAD) artery (Figures 2 & 3). Right coronary artery was dominant with no lesions.A seven French extra back-up catheter was placed in the ostium of the left coronary artery. Three guidewires were advanced: one in the LAD artery and the other two in the CX artery and branches. While crossing the CX occlusion with the wire, the vessel opened spontaneously (Figure 4) and an image suggestive of thrombotic material was seen in the CX and the second obtuse marginal branch ( Figure 5).Afterwards, 15 mg of intracoronary abciximab were infused and a zotarolimus drug eluting stent (Resolute Integrity 3,5x22 mm) was placed directly from the CX artery to the second obtuse marginal branch (Figures 6 & 7). a) In order to treat the distal LMCA lesion, a CULOTTE STENTING technique was used: b) A 3.5 x 30 mm zotarolimus drug eluting stent (DES) was implanted between the LM artery and CX, overlapped to the previous stent (CX, Figure 8).c) A guidewire was recrossed to LAD artery through the struts of the previously implanted stent (Figure 9).