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LAD Diagonal Bifurcation Intervention with Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 59-year-old female was admitted for dyspnea and chest pain on exertion. She had no previous coronary artery disease and underlying disease. Physical examinations were unremarkable. Simple radiography and echocardiogram showed normal findings.
Baseline Coronary Angiogram & OCT
  1. The left coronary angiogram showed discrete lesion at mid LAD and Diagonal branch. Mid LAD lesion was diffuse and occluded about 90% and a diagonal branch was tubular and about 80%. LCx was observed as normal ( Movie 1).
  2. The right coronary angiogram showed diffuse lesion with 80% occlusion at the mRCA portion.
Procedure
A 6 Fr radial sheath (Terumo) was inserted through the right radial artery and left coronary artery was engaged with a 6 Fr JR 4 guiding catheter. Two 0.014-inch BMW 190 cm wires were inserted into LAD and D1, respectively. Before the intervention, OCT was used to identify lesion characteristics of LAD and D1, in which diffuse LAD disease was identified with tight ostial stenosis of D1 ( Movie 2). Emerge NC balloon sized 2.5 x 15 mm was used to dilate stenotic lesion of mid LAD ( Movie 3) and diagonal branch ( Movie 4). XIENCE Sierra stent sized 2.5 x 15 mm was deployed at the lesion of diagonal branch and 2.75 x 33 mm was deployed at the lesion of pmLAD. After checking OCT and kissing balloon were applied using Sapphire NC balloon upto 6 atm (2.85) and Lacrosse balloon upto 6 atm (2.5) in pmLAD and diagonal branch espectively ( Movie 5). The final angiogram showed no stenotic lesion and good flow ( Movie 6).
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