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| - Operator
: Myeong-Ki Hong, MD, PhD, Seoul, Korea |
 Case
summary |
| This 63-year old male
patient was admitted with resting chest pain
for 2 weeks. Baseline coronary angiogram showed
the subtotal occlusion at the left anterior
descending artery (LAD) bifurcation (Figure
1). We planned the “Stent-crush”
for treatment of the lesion. |
| Procedural
steps and clinical experience of the Art balloon |
| After introducing two
wires into the LAD and diagonal branch, predilation
was performed in the LAD lesion (Figure
2 , Figure
3). And we deployed a 2.75x28mm
Cypher stent first in the distal LAD. Then
we introduced two Cypher stents into the LAD
and diagonal branch (Figure
4). After deploying a 2.5x24mm
Cypher stent in the diagonal branch (Figure
5), we removed the stent delivery
system in the diagonal branch to prevent the
trap of the wire in the diagonal branch during
stent deployment in the LAD. And we deployed
a 3.0x16mm Cypher stent towards the LAD (Figure
6). Although following angiogram
showed the successfully deployed stents in
the LAD and the diagonal branch (Figure
7), we tried to introduce a new
balloon system into the diagonal branch for
final kissing balloon dilatation. Many interventionists
recommend the final kissing balloon dilatation
in “Stent-Crush” for bifurcation coronary
lesion. Dr. A. Colombo presented that the
long-term angiographic result of “Stent-Crush”
technique without final kissing balloon dilatation
was not good as expected. And he suggested
that the final kissing balloon dilatation
may lead to a more favorable result by more
optimal stents (main branch and side branch)
apposition into the bifurcation arterial wall.
However, in his and our experiences, the re-crossing
of the balloon system into the side branch
after “Stent-Crush” was successful only in
50%. And we realized that the characteristics
of the used balloon system are very important.
The balloon should have a low profile
and a good pushability to cross the two overlapped
(crushed) stents. In this case, we
failed to cross the balloon system into the
diagonal branch several times. Finally we
succeed in re-crossing with the Art balloon
(Figure
8). We were very pleased at this
time because all of us involved in the procedure
knew the importance of final kissing balloon
dilatation. After final kissing balloon dilatation
(Figure
9), we achieved a very successful
result (Figure
10). We expected that the excellent
initial result would be translated into the
good long-term result. |
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