> Cases

Treatment of distal LMCA Bifurcation Stenosis Using Crushing Technique
- Operator: Seung-Jung Park, MD
Case Presentation
This 50-year old gentleman admitted our hospital due to effort related chest pain. His coronary risk factors were hyperlipidemia and smoking. The echocardiography showed normal left ventricular function (EF=63%) without regional wall motion abnormality.
Baseline Coronary Angiography
The left coronary angiogram showed tight narrowing of dLM bifurcation and intermediate stenosis at mLAD ( Movie 1, Movie 2, Movie 3). The right coronary was normal.
An 8 Fr JL 4.0 guiding catheter was engaged into the left coronary ostium. Two 0.014 BMW wires were inserted into the LAD and LCX, respectively (Figure 1). Predilatation for lesion modification was done using a Black Hawk 2.5 x 20mm balloon at LAD. The distal LMCA bifurcation lesion was treated by a Crushing technique. We sequentially deployed a Resolute integrity stent 3.0 x 22mm at the pLCX (Figure 2) and a Resolute integrity stent 3.5 x 30mm at the LM to pLAD (Figure 3). After removal of LCX wire, 0.014 Choice PT wire was reinserted into LCX. Thereafter, Sprinter legend 1.25 x 15 and Maverick 1.5 x 20 was sequentially dilated at LCX ostium. After dilatation with Dura Star 3.5 x 20 at pLAD and Dura Star 3.0 x 20 at pLCX (Figure 4, Figure 5), final kissing balloon dilation was performed with a Fortis 3.5 x 20mm in pLAD to LM and a Dura Star 3.0 x 20mm in pLCX to LM (Figure 6, Figure 7). Thereafter, to assess the functional significance of mLAD intermediate lesion ( Movie 4), FFR was measured and showed 0.68. Accordingly, Resolute integrity stent 3.0 x 22 was implanted overlapping with LM to pLAD stent (Figure 8). Final angiogram showed well-expanded and well-positioned stents ( Movie 5, Movie 6, Movie 7).
what is the prognosis?
Ricardo Quizhpe2012-01-03
My first concern was based on a trifurcation intervention. However, it seems that first diagonal did not need be wired. Then, what will be the case to protect the three vessels? Great case and final resolution using FFR.
Guanghui Chen2012-01-04
the immediate result was quite perfect, what I concern is the long-term effect.
Shih-Hung Chan2012-01-09
Excellent result.
Sign in to leave a comment.
CardioVascular Research Foundation (CVRF)
2nd Floor, Asan Institute for Education & Research, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
Tel_82.2.3010.4792 | Fax_82.2.475.6898
재단법인 심장혈관연구재단
대표이사 박승정 | 서울시 송파구 올림픽로43길 88, 서울아산병원 아산교육연구관 2층 | 사업자등록번호 215-82-06387
개인정보 관리책임자_노순정 | 전화번호_02.3010.4792 | 팩스번호_02.475.6898
Copyright © CVRF, Seoul, Korea. All rights reserved.