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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.
Procedure
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.
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