Coronary > Cases

LM Bifurcation Intervention with Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 50-year-old female was admitted for chest pain and dyspnea on exertion. She had no previous PCI history. Physical examination and a simple chest radiograph were unremarkable. Echocardiogram showed normal LV function without wall motion abnormality.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed diffuse 50-70% stenotic lesion at LM and both ostium of pLAD and pLCX ( Movie 1, Movie 2).
  2. The right coronary angiogram showed nearly 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 3.5 guiding catheter. Each two 0.014-inch BMW 190 cm wires 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. DESyne stent sized 3.0 x 18 mm at denovo LM to pLCx lesion and DESyne stent sized 3.5 x 23 mm at denovo LM to pLAD lesion were inserted without inflation simultaneously. First, the stent at LM to pLCx was inflated (Figure 1), thereafter the stent at LM to pLAD was inflated, so the proximal strut of the former was crushed (Figure 2). Sapphire NC balloon sized 3.0 x 15 mm was used to dilate stenotic lesion of pLCx, and so was Radien 3 sized 3.5 x 15 mm for stenotic lesion of LM to pLAD. IVUS was checked, and POT and kissing balloon were applied using Sapphire NC balloon 3.0 (15) upto 10atm (2.95) and Radien 3 3.5 (15) balloon upto 10 atm (3.44) in LM-pLCx and LM-LAD, respectively (Figure 3). The final angiogram showed no stenotic lesion and good flow ( Movie 4, Movie 5), and IVUS showed no immediate complications.
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