Tips & Tricks

Severe Ostial stenosis of LAD artery

1) Multiple Approaches

• Kissing stents as the first plan
• Wire both vessels LAD and circumflex and stent Ostium of LAD without struts of stents protruding into left main. Be exactly at the LAD Ostium to be seen in LAO caudial & RAO caudial view
• Keep a balloon inflated in circumflex and inflate at 2 to 3 ATM when deploy in stent at Ostium of LAD artery to prevent plaque shift.

2) Use of prophylactic IABP for 
Patients with Low EF 
Graft PTCA with Low EF 
Only remaining vessel angioplasty 
Multi vessel stenting with Low EF

3) Six French (FR) JL 3.5 guide gets sucked in the proximal LAD when removing balloon after deploying. EBU 3 guide is most steady and does not get sucked in the coronary.

4) Calcified lesion

• Mostly adventitial calcium so lesions are easily dilated with balloon
• Calcified lesions do not easily dissect with balloon dilation because they are hard and chronic.
• You can try NC balloon, angiosculpt, rotablator.