LAD Trifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LAD Trifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 51 year-old male was admitted with effort chest pain lasting for an year. His coronary risk factors were hyperlipidemia. The physical examination was normal. His baseline ECG and cardiac markers were unremarkerable.
Baseline Coronary Angiography
  1. The left coronary angiography showed diffuse subtotal occlusion of proximal to mid LAD, severe stenosis of 1st diagonal branch, tight stenosis of 2nd diagonal branch.( Movie 1, Movie 2)
  2. The right coronary angiogram was mild diffuse stenosis of mid RCA and moderate diffuse stenosis of PDA.( Movie 3)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL catheter with 4.0 cm curve. 0.014-inch 180cm Sion wire was inserted into the 1st diagonal branch. 0.014-inch 180cm Sion wire was inserted into the 2nd diagonal branch. And 0.014-inch 180cm Fielder XT wire was inserted into the LAD. Proximal to mid LAD was pre-dilated with 3.0 X 20mm Quantum balloon.(Figure 1) And then, we pre-dilated 1st diagonal branch using 2.0 X 15mm Tazuna balloon.(Figure 2) Thereafter a Xience Alpine 3.0 X 18 mm Stent was successfully deployed at 2nd diagonal branch, firstly.(Figure 3) Another Xience Alpine 2.75 X 18 mm Stent was successfully deployed at 1st diagonal branch.(Figure 4) And then a Xience Alpine 3.25 X 38 mm Stent was successfully deployed at mid to proximal LAD by crushing.(Figure 5) And 0.014-inch 182cm Choice PT wire was inserted into the 2nd diagonal branch. Additional kissing ballooning was performed by using a NC TREK 3.5 X 15mm at proximal LAD and a Quantum 2.75 X 15mm at 2nd diagonal branch.(Figure 6). And then, 0.014-inch 182cm Choice PT wire was reinserted into the 1st diagonal branch. Additional kissing ballooning was performed by using a NC TREK 3.5 X 15mm at proximal LAD and a Quantum 2.75 X 15mm at 1st diagonal branch.(Figure 7). Final left angiogram and IVUS showed that the procedure was successful.( Movie 4, Movie 5)

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