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LM Trifurcation Disease with Mini-Crushing Technique and Kissing Balloon
- Operators: Seung Jung Park. Young Hak Kim
Clinical presentation

A 62-year old man was suffered from effort chest pain for 3 months. So, He visited our hospital and got coronary angiography. That coronary angiogram showed tight stenosis of proximal RCA & left main trifurcation disease. So, He had a PCI at pRCA 1 month ago. His coronary risk factors were diabetes, hypertension and smoking. Baseline ECG showed normal sinus rhythm. Echocardiography revealed hypokinesia of basal inferior wall and normal LV systolic function.

Baseline coronary angiogram

1. Left coronary angiogram showed 70% narrowing of distal LM, diffuse 60-70% narrowing of pLAD, 90-95% narrowing of LCX os and diffuse 90% narrowing of ramus intermedius(RI).(Figure 1)
2. Right coronary angiogram showed patent previous stent.

Procedure
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr EBU guiding catheter with 3.5cm curve. A 0.014 inch BMW wires was inserted into the LAD, LCX and RI. Cypher 3.0 X 33mm stent was deployed at RI diffuse lesion without predilatation. (Figure 2) And Another Cypher 3.5 X 33mmm stent was deployed at LM to pLAD with mini-crushing technique without predilatation. (Figure 3) Another 0.014 inch Rinato wire was reinserted into the RI. We planned additional 'kissing balloon post-dilation' at LM-pLAD, RI and LCX. We performed kissing balloon with 3.5 X 12mm Quantum at LM-pLAD, 3.0 X 12mm Quantum at RI and 2.5 X 20 mm at LCX respectively (Figure 4, Figure 5). IVUS study was done about LAD and RI. IVUS findings revealed underexpanded LAD & RI stent. So we planned additional kissing balloon post-dilation at LM-pLAD and RI. We performed kissing balloon with 3.5 X 12mm Quantum at LM-pLAD and 3.0 X 12 Quantum mm at RI respectively (Figure 6). And then, IVUS study was performed. IVUS findings showed good stent position at LM-pLAD and RI (Figure 7, Figure 8). Final left angiogram showed that the procedure was successful (Figure 9).
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