LM Bifurcation Disease Teated with Mini-Crushing Technique

- Operator : Antonio Colombo

LM Bifurcation Disease Teated with Mini-Crushing Technique
- Operators: Antonio Colombo, Yang-Soo Jang
Clinical presentation
A 52-year old man was admitted for follow up coronary angiography without symptom. She had a history of PCI at proximal to distal RCA and Diagonal branch with Endeavor stent 9 months ago. Her coronary risk factors were hypertension and hyperlopidemia. Baseline ECG showed normal sinus rhythm. Echocardiography revealed no regional wall motion abnormality and normal LV systolic function. Other non-invasive tests were not done.
Baseline coronary angiogram

1. Left coronary angiogram showed 70% narrowing of distal LM, 80 narrowing of LAD os & diffuse 70% narrowing of pLCX (Figure 1, Figure 2)
2. Right coronary angiogram showed patent previous stents.

Procedure
A 8Fr sheath was inserted into the right femoral artery, and the left coronary ostium was engaged with a 8Fr XB guiding catheter with 3.5cm curve. A 0.014 inch BMW wires were inserted into the LAD and LCX(2 wires). Initially, we planned pre-dilation with 2.5 X 15mm Maverick balloon pLCX (Figure 3, Figure 4). IVUS study was done about LCX & LAD. IVUS findings revealed heavy plaque burden in the pLCX, LAD os and distal LM (Figure 5, Figure 6, Figure 7). Initially, we planned mini-crushing with Taxus liberte 2.5 X 24mm at LCX and Taxus liberte 3.5 X 38mm at distal LM to LAD (Figure 8, Figure 9). Another 0.014 inch Rinato wire was inserted into the LCX. And then additional post-stent balloon dilation was performed with 2.5 X 15mm Maverick at LCX and 4.0 X 8mm Quantum at distal LM to pLAD. We performed kissing balloon with 4.0 X 8mm Quantum at LM-proxmal LAD and 2.5 X 13 mm Fortis at LCX respectively (Figure 10). And then, IVUS study was performed. IVUS findings showed good stent position at pLAD and LCX (Figure 11, Figure 12). Final left angiogram showed that the procedure was successful (Figure 13, Figure 14).
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Comments

  • Yong He 2008-05-09 Excellent technique and perfect result, however, I don't think the patient could benefit more from the Lcx stenting.
  • Young-Hak Kim 2008-09-22 Although the data is limited, complete revascularization may lead to better long-term outcomes compared with incomplete revascularization. The procedure at LCX did not expense much time, effort, and cost.

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