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Distal Left Main Trifurcation Lesion Treated by Crush Technique
- Operator: Seung-Jung Park, MD

A 60-year-old man was admitted with stable angina pectoris 10 months ago. His coronary risk factors were hypertension, hyperlipidemia, diabetes, and smoking. The echocardiography showed normal left ventricular function (EF=65%) without regional wall motion abnormality. ECG and cardiac enzyme were within normal limit.

Baseline coronary angiography

1. The left coronary angiogram showed significant stenosis at distal LM trifurcation lesion. ( Movie 1, Movie 2)
2. The right coronary angiogram showed mild stenosis at mRCA.

Procedure

An 8 Fr JL 4 guiding catheter with side hole was engaged in the left coronary artery through the 8Fr sheath. First of all, LAD, RI, and LCX were wired with a 0.014 BMW wire respectively. Predilatation with Dura Star 2.75x15 at pLCX was performed. And Xience V 2.75x18mm was implanted. (Figure 1) Maverick 3.5x15mm balloon was inflated at LM to pLAD. (Figure 2) Using Crushing technique, Xience V 3.5x28mm at LM to pLAD and Xience V 2.75x18mm at LCX were deployed. (Figure 3, Figure 4) Choice PT 0.014 wire was inserted at RI and BMW 0.014 wire was inserted at LCX. Then Final kissing balloon inflation using Nimbus 3.5x17mm and Dura Star 2.75x15mm was applied. (Figure 5) Final angiogram showed well-expanded and well-positioned stents without compromised side branch flow. (Figure 6)

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