LM Bifurcation Stenting with Crush Technique

- Operator : Jung-Min Ahn

LM Bifurcation Stenting with Crush Technique

- Operator: Jung-Min Ahn, MD

Case Presentation

A 81 year-old male patient was admitted for dyspnea on exertion. coronary risk factor was hypertension, diabetes mellitus and ex-smoking. He underwent the percutaneous coronary intervention on pmLAD due to acute myocardial infarction at other hospital, 4 months ago. Before admitting to our hospital 2 weeks ago, he started showing symptoms of heart failure. The physical exam was normal. The ECG showed inferior Q waves. Echocardiogram showed multiple wall motion abnormality and moderate LV systolic function(EF: 39%).

Baseline Coronary Angiogram & IVUS

Left and coronary angiogram, IVUS showed severe stenosis at distal LM, severe stenosis at proximal LAD and severe stenosis at proximal LCX (Figure 1, Figure 2). The right coronary angiogram showed chronic total occlusion at pRCA.

Procedure

A 8Fr sheath was inserted thorough right femoral artery and left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into LAD and 0.014-inch BMW 190 cm wire was inserted into LCX. A 9r sheath was inserted thorough left femoral artery and IABP was inserted to prepare for cardiogenic shock. SAPPHIRE 2.5(20) balloon was used for predilatation. Then, XIENCE Alpine 2.75 x 18 mm was successfully deployed at proximal LCX and XIENCE Alpine 3.5 x 33 mm was successfully deployed at LM to proximal LAD by Crush technique ( Movie 1, Movie 2). And additional NC balloon was performed by using Raiden 3 3.5 x 20 mm at LM and SAPPHIRE NC 3.0 X 18 mm at LCX. Additional kissing ballooning was performed by using SAPPHIRE NC 3.0 X 18 mm at proximal LCX and Raiden 3 3.5 x 20 mm at LM to proximal LAD ( Movie 3). And additional NC balloon was performed by Raiden 3 3.5 x 20 mm at LM os for optimization. Final angiogram and IVUS showed that the procedure was successful (Figure 3, Figure 4). Then IABP was removed due to stable vital sign.