LM Bifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Relevant clinical history and physical exam
A 65 year-old gentleman visited our hospital because of recurrent episodes of angina. He already underwent PCI with Promus Element stents at mLAD and dRCA 5 months ago. Treadmill exercise test showed ST depression at stage 3. He had hypertension and dyslipidemia.
Relevant catheterization findings
The left coronary angiogram showed tubular 70 to 80% stenosis of LM, diffuse 70 to 80% stenosis of proximal LAD and diffuse 60-80% stenosis of proximal to distal LCX ( Movie 1, Movie 2). The previously inserted stent at mLAD and dRCA was patent (Figure 1).
Procedural step
A JL4 SH 8Fr guiding catheter was engaged into the left coronary artery through the right femoral artery. A 0.014-inch BMW wire and a 0.014-inch Soft wire were inserted into the LAD and LCX, respectively. We pre-dilated pLCX using a Black Hawk 2.5 x 20 mm balloon; LM to pLAD using a Black Hawk 2.5 x 20 mm balloon. Thereafter, we deployed a Promus Element 3.0 x 30 mm stent at pLCX (Figure 2) and another Promus Element 4.0 x 20 mm stent at LM to pLAD with ¡°Crushing technique¡± ( Movie 3). After that, we pre-dilated dLCX using an Ikazuchi 2.0 x 15 mm balloon, and then deployed a Promus Element 2.5 x 24 mm stent at dLCX (Figure 3). Adjunctive post-stenting balloon dilatation was done using a Nimbus Salvo 3.5 x 17 mm at LM to pLAD and a Dura Star 3.0 x 20 mm at pLCX. Final kissing ballooning was performed using a Nimbus Salvo 3.5 x 17mm at LM-pLAD and a Dura Star 3.0 x 20mm at pLCX ( Movie 4). Post procedural left angiogram showed that the procedure was successful ( Movie 5, Movie 6).

Comments

  • 2011-11-08 it is avery illustrative case but is CABG is discussed?
  • Joao Alexandre Farjalla 2011-11-24 Great result!!!
  • Long Bui 2012-01-27 Fantastic result. Could we do this case if there is no IVUS in the cathlab? Is it mandatory to do IVUS after stenting?

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