Slides Coronary Bifurcation
LAD Bifurcation Treated by Balloon Crush Technique
- Operator : Duk-Woo Park
LAD Bifurcation Treated by Balloon Crush Technique |
- Operator: Duk-Woo Park, MD |
Case Presentation |
A 58 year-old female was admitted with effort chest pain for a year. Her coronary risk factors were hyperlipidemia and diabetes mellitus. The physical examination was normal. Her baseline ECG and cardiac markers were unremarkable. She received drug-eluting stent (Promus 3.5 x 28 mm) implantation at proximal to mid RCA about 1 year ago due to acute myocardial infarction. Echocardiography showed a normal left ventricular ejection fraction of 55% with regional wall motion abnormality of the RCA territory. |
Baseline Coronary Angiography |
Procedure |
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL 4.0 catheter. 0.014-inch 190cm BMW wire was inserted into the LAD. Considering tight bifurcation lesion of LAD, we planned PCI with 2 stents by crush technique. First, we pre-dilated proximal to mid LAD using 2.5 x 20 mm Lacrosse balloon and then, 0.014-inch 180cm Runthrough NS wire was inserted into the 1st diagonal branch. We dilated proximal to mid LAD using 2.75 x 20mm Quantum balloon (Figure 1) and 1st diagonal branch using Lacrosse 2.5 x 20 mm (Figure 2). Thereafter a Resolute Onyx 2.5 x 26 mm stent was successfully deployed at 1st diagonal branch (Figure 3). And then we did balloon crush with 2.75 x 20 mm Quantum balloon (Figure 4). Because of heavy calcification of proximal to mid LAD, there was difficulty in stent delivery even after dilatation with 3.5 x 10 mm Flextome cutting balloon (Figure 5). So 5F heart rail was used to implant Resolute Onyx 3.5 x 22 mm and 4.0 x 22 mm stents at proximal to mid LAD (Figure 6, Figure 7). And 1st diagonal branch rewired with 0.014-inch 180cm Choice PT. Final kissing ballooning was performed by using an Empira NC 3.5 x 20 mm at proximal to mid LAD and a Lacrosse 2.5 x 20 mm at the 1st diagonal branch (Figure 8). Final left angiogram showed that the procedure was successful ( Movie 4, Movie 5). |
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