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LM Bifurcation and ISR Lesion Intervention with Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 76-year-old male was admitted for effort chest pain. He had no previous PCI history Physical examination and a simple chest radiograph were unremarkable. Echocardiogram showed normal LV dysfunction without wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The left coronary angiogram showed diffuse 70% stenotic lesion at distal LM and both ostium of pLAD and pLCX ostium ( Movie 1, Movie 2).
  2. The right coronary angiogram showed normal ( Movie 3).
Procedure
A 8 Fr femoral sheath (Terumo) was inserted through the right femoral artery and left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. A 0.014-inch BMW 190 cm wire and a 0.014-inch Sion 180cm wire were inserted into LAD and LCX, respectively. Before the intervention, IVUS was used to identify lesion characteristics of LAD and LCX, in which diffuse LM disease was identified with tight ostial stenosis of LAD and LCX (Figure 1 with LCX). XIENCE Sierra stent sized 2.5 x 18 mm was deployed at denovo RI lesion and XIENCE Sierra stent sized 3.25 x 15 mm at denovo pLCX lesion respectively. Sapphire NC balloon sized 3.75 x 15 mm was used to dilate stenotic lesion of LM-proximal LAD ( Movie 4). After dilation of LM-pLAD, IVUS was done. XIENCE Sierra stent sized 3.0 x 38 mm was deployed at denovo LM lesion ( Movie 5). After checking IVUS, POT and kissing balloon were applied using Sapphire NC 3.75 (15) upto 10atm (3.68) and NC Emerge balloon upto 10 atm (3.2) in LM-pLAD, pLCX, respectively ( Movie 6). The final angiogram showed no stenotic lesion and good flow, and IVUS showed no immediate complication ( Movie 7).
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