Video 3. LAO cranial angiogram demonstrating the severe diagonal lesion (which was notable for the absence of apparent calcification). The native second diagonal branch contained a tubular, non-calcified 99% stenosis in the proximal third of the vessel (Figure 1, Videos 2 and 3). Rather than re-intervene on the 12-year-old vein graft, which was now totally occluded, a decision was made to intervene on the subtotally occluded native diagonal branch.
A 6 French XB 3.5 (Cordis) guiding catheter was used to engage the left coronary artery and anticoagulation was achieved using intravenous bivalirudin. A Runthrough NS (Terumo) guide wire was used to cross the lesion. An Emerge (Boston Scientific) 2.25mm x 15mm compliant balloon was inflated multiple times.
Antony G. Kaliyadan, MD, Henry Siu, MD, David L. Fischman, MD, Nicholas J. Ruggiero II, MD, Brandon M. Madsen, BS, and Michael P. Savage, MD, Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania