LM Bifurcation Lesion with Severe Calcifications Treated by Crushing Technique

- Operator : Antonio Colombo

LM Bifurcation Lesion with Severe Calcifications Treated by Crushing Technique

- Operators: Antonio Colombo, MD, Chi Kin Chan, MD

Case Presentation

A 56 year-old man was admitted with effort-related chest pain for 10 days. His coronary risk factors were hypertension and hyperlipidemia. He had a history of chronic renal failure due to membranous glomerulonephritis. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=61%) without RWMA.

Baseline Coronary Angiography

1. The left coronary angiogram showed significant stenosis at distal LM bifurcation lesion with severe calcifications ( Movie 1). 2. The right coronary angiogram was near-normal ( Movie 2).

Procedure

An 8 Fr EBU 3.5 guiding catheter was engaged at the left coronary artery ostium through right femoral artery. They inserted a 0.014 inch BMW wire into LAD and a 0.014 inch Sion wire into LCX, respectively. Firstly, they performed intravascular ultrasound (IVUS) evaluation from LM to LAD and LM to LCX, respectively. LCX ostium showed a heavy plaque burden on IVUS examination. So, they planned to treat the LM bifurcation lesion using a crushing technique. Predilatations using a Quantum 2.0x15mm balloon were performed at LM to LCX and LM to LAD, sequentially (Figure 1). They deployed a Xience Prime 3.0x12 mm stent at LM to LCX. Then, they performed crushing of LCX stent with a Xience Prime 3.5x12 mm stent at LM to LAD (Figure 2). Additional balloon dilatations were performed with Maverick 2.0x15 mm and Quantum 3.0x15 mm balloons at LM to LCX and with a Fortis 3.5x15 mm balloon at LM to LAD. Kissing balloon dilation was performed with a Fortis 3.5x15 mm balloon at LM to LAD and with a Quantum 3.0 x 15mm balloon at LM to LCX (Figure 3). After adjunctive balloon dilatation with a Quantum 3.0x15mm at LM to LCX, final kissing balloon dilation was performed with a Fortis 3.5x15 mm balloon at LM to LAD and with a Quantum 3.0 x 15mm balloon at LM to LCX. And then, they checked the FFR value of LCX to evaluate intermediate lesion at proximal LCX. The FFR value of LCX was 0.96. Final angiogram ( Movie 3, Movie 4) and IVUS showed well-expanded and well-positioned stents.