An anterior descending branch opening lesion is defined as a lesion within 3 mm proximal to the beginning of the LAD.
The staging includes.
① severe stenosis at the beginning of the LAD with a plaque involving the end of the left main stem;
②Severe stenosis at the beginning of the LAD, but the plaque does not involve the LM;
(iii) “Bridgeport type” (i.e., anterior descending branch opening with normal vascular segment), which has a higher restenosis rate than other non-oral lesions because the orifice lesion has more elastic fibers and undergoes significant elastic retraction after dilatation. Therefore, the choice of treatment strategy is particularly important.
Since 2003, Prof. Jilin Chen has been exploring the treatment of anterior descending orofacial lesions and observing the long-term results, and has concluded that the strategies for interventional treatment of anterior descending orofacial lesions include
①Precise positioning method;
② “Crossover” stent placement method;
③SKB (stent kissing balloon) stent insertion method.
1. The prerequisites for precise positioning are
①LAD initiating plaque does not involve LM;
②The LAD should be applied if the angle between LAD and LCX is ≥60°. However, if the stent is encountered to move with the heartbeat, the following is a simple and effective method to suppress the stent movement is recommended.
①First feed a guide wire to the distal end of the LCX;
②Subsequently, a 2.5 mm balloon is inserted into the LCX, with the anterior end of the balloon entering the left main stem by about 2 mm;
③Fill the balloon to 4-5Atm, at which time the movement of the stent can be completely inhibited. Similarly, if the lesion at the opening of the gyral branch moves with the heartbeat, it can be treated in the same way.
2.Crossover stent placement method: Applicable to the following cases.
①The plaque at the beginning of the LAD accumulates at the end of the LM;
②The angle between LAD and LCX is small (<60°);
③No obvious stenosis lesion at the beginning of LCX (stenosis <50%).
3. SKB stent placement method.
When the anatomical characteristics of the anterior descending posterior lesion cannot meet the conventional interventional treatment of posterior lesion, an innovative stent placement method (SKB technology) with stent and balloon kissing is recommended if the following conditions are met: the LM caliber is significantly larger than the LAD caliber (1mm); the angle between the LAD and LCX is small; and the LCX orifice is No significant stenotic lesions.
The procedure of the SKB method is as follows
① Place the guiding wire in the LAD and LCX;
②The LAD stent was inserted into the left main stem by 1~2 mm;
(3) Place a balloon at the LCX with the proximal marker slightly in front of the proximal marker of the stent by 1 to 2 mm.