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Crush Technique for the LM Bifurcation Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 51-year-old male was admitted for unresolved effort chest pain even after PCI at the other hospital. He recently had coronary stenting at the proximal to mid LAD, but his chest discomfort was not improved. His coronary risk factor was diabetes mellitus and ex-smoking. The physical exam was unremarkable, the electrocardiogram showed ST depression and T wave inversion in V4-6. The echocardiography showed moderate LV dysfunction with the ejection fraction of 45%.
Baseline Coronary Angiogram
  1. The left coronary angiogram & IVUS showed significant stenosis LM bifurcation lesion. Severe eccentric stenosis at the LCX ostium was remarkably identified. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed diffuse stenosis. ( Movie 3)
Procedure
An 8Fr sheath was inserted through the right femoral artery and, left coronary artery was engaged with an 8 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into the LAD and LCX. Pre-dilation performed with a SAPPHIRE NC 3.0 x 18 mm balloon. The Xience stent 3.5 x 26 mm was deployed at LCX ( Movie 4). The Raiden 3 balloon 4.0 x 20 mm was used at LM-pLAD. Then, another Xience stent 4.0 x 18 mm was deployed with crush technique ( Movie 5).
The kissing balloon was performed by using Raiden 3 4.0 x 20 mm and Sapphire NC 3.0 x 18 mm balloon at pLAD and pLCX ( Movie 6). The final angiogram and IVUS showed successfully implanted stents ( Movie 7, Movie 8).

Appendix
IVUS image of pre-procedure and final image ( Movie 9, Movie 10).
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