Distal Left Main Bifurcation Lesion Treatment Using Stent Crushing and Kissing Balloon Technique

- Operator : Imad Sheiban

Distal Left Main Bifurcation Lesion Treatment Using Stent Crushing and Kissing Balloon Technique
- Operators: Imad Sheiban, MD, Huay Cheem Tan, MD
Case Presentation
A 53-year-old man visited to our hospital because of an effort-related chest pain for 3 weeks. Nine years ago, he underwent PCI at proximal to mid LAD (Cypher 3.0 X 33+3.0 X 28mm) and at proximal LCX to OM1 (Cypher 2.75 X 18mm). His coronary risk factors were hypertension and hyperlipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. Treadmill test was positive at stage II with symptom.
Baseline Coronary Angiogram
1. The left coronary angiogram showed tight stenosis at distal LM bifurcation, patent previous stents at proximal to mid LAD and proximal LCX to OM1, total occlusion of distal LCX ( Movie 1). 2. The right coronary angiogram showed diffuse mild stenosis ( Movie 2).
Procedure
An 8 Fr XB 3.5 guiding catheter was engaged at the left coronary artery ostium through right femoral artery. First, they inserted a 0.014 inch BMW wire into LAD and a 0.014 inch Miracle 3 wire into LCX using FINECROSS 0.014 inch (1.8 Fr) Micro-Guide catheter, respectively. Next, they exchanged the Miracle 3 wire in LCX into a 0.014 inch BMW wire anchoring with a Ryujin 2.5 x 15 mm balloon and introduced further into the OM branch. Then predilatation using a Ryujin 2.5 x 15 mm balloon were performed at LM to LCX and LM to LAD, sequentially (Figure 1, Figure 2). They deployed a Resolute integrity 3.0x12 mm stent at LM to LCX (Figure 3). They performed crushing of LCX stent with a Resolute integrity 3.5 x 12 mm stent at LM to LAD (Figure 4). Additional balloon dilatations were performed with a Maverick 1.5 x 15 mm balloon and a Empira NC 3.0 x 15 mm balloon at LM to LCX and with a NC TREK 3.5x15 mm balloon at LM to LAD. Final kissing balloon dilation was performed with a NC TREK 3.5x15 mm balloon at LM to LAD and with a Empira NC 3.0 x 15 mm balloon at LM to LCX (Figure 5). Final angiogram ( Movie 3) showed that the procedure was successful.

Leave a comment

Sign in to leave a comment.