Slides

LM Bifurcation Lesion Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Lesion Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 53 year-old male was admitted with effort related chest pain. His coronary risk factors were diabetes mellitus, dyslipidemia, and ex-smoking. The physical examination was normal. His baseline ECG and echocardiogram was normal. Treadmill test was positive at stage III with symptom. The thallium scan showed reversible large sized perfusion defect in multi-vessel territory. He refused to undergo CABG.
Baseline Coronary Angiography
1. A left coronary angiogram showed significant stenosis of distal LM bifurcation ( Movie 1, Movie 2).
2. A right coronary angiogram showed significant stenosis at proximal RCA ( Movie 3).
Procedure
A 8 Fr JL4 guiding catheter with side holes was engaged into the left coronary artery through right femoral approach. Two 0.014-inch BMW wire were placed into the LAD and LCX. We directly deployed 3.5 x 22 mm Resolute integrity stent at distal LM to proximal LCX (Figure 1). We performed balloon crushing with 3.5 x 15 mm Empira NC at LM to proximal LAD (Figure 2). Then, a 3.5 x 30 mm Resolute integrity stent was successfully deployed at LM to proximal LAD (Figure 3). We re-insert a 0.014 inch BMW wire into LM to proximal LCX. And then additional kissing ballooning was performed by using a 4.0 x 15 mm Empira NC balloon at LM to proximal LAD and a 3.5 x 15 mm Empira NC balloon at LM to proximal LCX (Figure 4). Sequentially, a 7F JL4 guiding catheter with side holes was engaged into the right coronary artery. The 0.014-inch BMW wire was inserted into RCA. Direct stenting was performed using 4.0 x 15 mm Resolute integrity stent at proximal RCA (Figure 5), and adjunctive high pressure balloon dilatation was performed with Empira NC balloon 4.0 x 15 mm (Figure 6). Final angiogram showed that the procedure was successful ( Movie 4, Movie 5, Movie 6).

Comments

  • Wang Gang 2013-07-12 A very good LM case with crush technique !
  • Bing Liu 2013-07-12 NIce case but inapposite strategy! And IVUS-guided PCI was neccesary! Why crush-tech!? Cullote was the suitable strategy based on the artery size and angle of the LM bifurcation! And cullote tech makes full coverage of the crina, which leads better long-term outcomes!
  • Zhonghan Ni 2013-07-18 Professor Park,Do you think performing post-dilatation with a same size NC balloon effective?

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