Crush Technique for the LM Bifurcation Lesion

- Operator : Duk-Woo Park

Crush Technique for the LM Bifurcation Lesion
- Operator: Duk-Woo Park, MD
Case Presentation
A 75-year-old male was admitted for effort chest pain. His coronary risk factor was diabetes mellitus and ex-smoking. The physical exam was unremarkable, the electrocardiogram showed normal sinus rhythm. The echocardiography showed concentric LVH with normal LV systolic function of LVEF 58%.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed significant stenosis at LM bifurcation ( Movie 1).
  2. The right coronary angiogram showed the chronic total occlusion at the proximal RCA ( Movie 2). PCI for RCA was done 2 days ago ( Movie 3).
Procedure
An 8Fr sheath was inserted through the right femoral artery and, left coronary artery was engaged with an 8 Fr XB 4 guiding catheter. 0.014-inch BMW 190 cm wire for LAD and 0.014-inch Sion 180cm wire for LCX was inserted. Pre-dilation performed with a Neon NC 3.5 x 15 mm balloon for the LCX ( Movie 4) and LAD ( Movie 5). Because the balloon could not pass through the LAD, rotablation with 1.5 burr rotablator was done for the LAD up to 190000 rpm 3 times ( Movie 6). Further pre-dilatation for the LAD was done with NC TREK 2.5 x 15 mm balloon ( Movie 7). The Xience stent 3.0 x 38 mm was deployed at the LAD ( Movie 8). The Xience stent 4.0 x 18 mm was deployed at the LCX ( Movie 9). The NEON NC balloon 3.50 x 15 mm was used at the LM-pLAD ( Movie 10). Then, another Xience stent 4.0 x 33 mm was deployed to the LM-pLAD with the crush technique ( Movie 11). Re-wiring of the LCX was done with 0.014-inch Sion 180cm wire. Then, in stent ballooning at the LCX ostium was done with Euphora balloon 1.5 x 15 mm ( Movie 12). Additional ballooning was done to LAD with NEON NC 3.5 x 15mm ( Movie 13) and Sapphire NC 4.0 x 18 mm balloon ( Movie 14).
The kissing balloon was performed by using Sapphire NC 4.0 x 15 mm balloon at the LAD and Raiden 3 4.0 x 15 mm at LCX ( Movie 15). The final angiogram and IVUS showed successfully implanted stents ( Movie 16).

Appendix
IVUS image of pre-procedure and final image ( Movie 17, Movie 18 for LAD and Movie 19, Movie 20 for LCX).

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