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LM Bifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 59 year-old male was admitted with effort chest pain for 6 months. His coronary risk factor was hypertension. The physical examination was normal. His baseline ECG and cardiac markers were unremarkerable.
Baseline Coronary Angiography
  1. The left coronary angiography showed discrete 80% stenosis of distal LM, diffuse 80% stenosis of LAD ostium, subtotal occlusion of LCX ostium with Medina classification (1,1,1) ( Movie 1, Movie 2).
  2. The right coronary angiogram showed subtotal occlusion of proximal RCA ( Movie 3).
Procedural Steps
An 8F sheath was inserted through right femoral artery, and the right coronary artery was engaged with an 8F JR catheter. Resolute integrity 3.0 X 22 stent was deployed in pRCA before left coronary artery procedure.
Then, the left coronary artery was engaged with an 8F JL 4.0. 0.014-inch 190cm BMW wire was inserted into the LCX and another 0.014-inch 190cm BMW wire was inserted into the LAD. A Resolute integrity 3.5 X 12 mm Stent was positioned in pLCX and another Resolute integrity 3.5 X 26 mm Stent was positioned in distal LM to proximal LAD. The pLCX stent was successfully deployed ( Movie 4). And distal LM-proximal LAD stent was deployed, crushing that portion of the LCX stent lying in the LM ( Movie 5). 0.014-inch 182cm Choice PT wire was inserted into the LCX. Additional kissing ballooning was performed by using a Quantum 3.5 X 15 at dLM-pLAD and a Pantera LEO 3.5 X 20mm at pLCX ( Movie 6). Final left angiogram and IVUS showed that the procedure was successful. ( Movie 7)
Shaopeng Xu2014-11-08
Since the diameter of LAD and LCX is equal, is culotte more sutable to this lesion?
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