|Proximal LAD Bifurcation Lesion Treated by Crush Technique|
|- Operator: Seung-Jung Park, MD|
|A 63 year-old man was admitted with effort chest pain for one year. His coronary risk factors were hypertension and diabetes mellitus . The echocardiography showed normal left ventricular function (EF=59%) without regional wall motion abnormality. Thallium scan showed partially reversible large sized perfusion defect at LAD territory.|
|Baseline Coronary Angiography|
|1. The left coronary angiogram showed tubular 90% stenosis of proximal LAD ( Movie 1, Movie 2, Movie 3, Movie 4, Movie 5).
2. The right coronary angiogram showed mild stenosis of mid RCA ( Movie 6).
|An 8 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with an 8Fr JL 4.0 catheter with side hole. Two 0.014 inch BMW wires were inserted into the LAD and the first diagonal branch. First, we checked the bifurcation lesion with IVUS( Movie 7: LAD, Movie 8: diagonal branch). We pre-dilated the LAD and the diagonal branch using a Ikazuchi 2.0 x 20 mm. Thereafter, we deployed a Xience Prime stent 2.75 x 23mm at D1 (Figure 1). We performed crushing with a Xience Prime stent 3.5 x 28mm at proximal LAD (Figure 2). Adjunctive post-stenting balloon dilatation was done using a Ikazuchi 2.0 x 20mm at the D1 and a Dura Star 3.5 x 20mm at the LAD. Additional kissing ballooning was performed by using a Dura Star 3.5 x 20mm at the LAD and a Dura Star 2.75 x 20mm at D1 (Figure 3). Final left angiogram and IVUS showed that the procedure was successful ( Movie 9, Movie 10).|