LM Trifurcation Lesion with In-Stent Restenosis Treated by Crush Technique

- Operator : Seung-Jung Park

LM Trifurcation Lesion with In-Stent Restenosis Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 74 year-old male was referred to our hospital for a second opinion. 2 years ago, he underwent percutaneous coronary intervention (PCI) at proximal LAD because of unstable angina. 6 months ago, the follow-up coronary angiogram showed severe stenosis at distal left main (LM) coronary artery with concomitant involvement of proximal LAD, LCX and ramus intermedius. His coronary risk factors were hypertension and hyperlipidemia. His baseline ECG and cardiac markers were unremarkable.
Baseline Coronary Angiography
  1. The left coronary angiogram showed severe stenosis at LM trifurcation with instent-restenosis at proximal edge of proximal LAD stent.( Movie 1, Movie 2)
  2. The right coronary angiogram showed diminutive RCA.(Figure 1)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL catheter with 4.0 cm curve. The 0.014-inch 190cm Balanced Middleweight (BMW) wire was inserted into the LAD and another BMW wire was inserted in to the LCX. LM to proximal LAD was pre-dilated with 3.0 X 15mm non-compliant (NC) TREK balloon.(Figure 2) And we also pre-dilated LM to proximal LCX using the same balloon.(Figure 3) Thereafter a Xience Alpine 4.0 X 18 mm stent was successfully deployed at LM to proximal LCX.(Figure 4). And then kissing ballooning was performed by using a NC TREK 3.5 X 15mm at LM to proximal LCX and a SeQuent Please 3.5 x 17mm at LM to proximal LAD.(Figure 5). Final left angiogram and IVUS showed that the procedure was successful.( Movie 3, Movie 4)

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