LM Bifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 60 year-old male was admitted with effort chest pain for 4 months. His coronary risk factors were hypertension, diabetes, history of cerebrovascular infarct and ex-smoker. The physical examination was normal. His baseline ECG and cardiac markers were unremarkerable.
Baseline Coronary Angiography
  1. The left coronary angiography showed subtotal occlusion of distal LM, subtotal occlusion of LAD ostium, subtotal occlusion of LCX ostium and tubular 70% stenosis of middle LAD with Medina classification (1,1,1). ( Movie 1, Movie 2)
  2. The right coronary angiogram was normal. ( 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 3.5 cm curve. 0.014-inch Runthrough NS wire was inserted into the LCX. 0.014-inch 190cm BMW guidewire was inserted into the LAD. Proximal LAD to LM was predilated with 2.0 x 20mm Tazuna balloon. And then, we pre-dilated pLCX using 2.0 X 20mm Tazuna balloon.(Figure 1) A Resolute integrity 3.5 X 12 mm Stent was successfully deployed at pLCX.(Figure 2) We performed crushing with a Empira NC 3.5(15) at dLM to pLAD.(Figure 3) And a Resolute integrity 4.0 X 22 mm Stent was successfully deployed at distal LM to proximal LAD.(Figure 4) And 0.014-inch Runthrough NS wire was inserted into the LCX. Additional kissing ballooning was performed by using a Empira NC 3.5(15) at dLM-pLAD and a SAPPHIRE NC 3.5 X 15mm at pLCX.(Figure 5) Thereafter, A Resolute integrity 3.5 X 18 mm Stent was successfully deployed at mLAD. Final left angiogram and IVUS showed that the procedure was successful.( Movie 4, Movie 5)

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