LM Bifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Crush Technique

- Operator: Seung-Jung Park, MD

Case Presentation

A 64-year-old man was admitted with resting chest pain. His risk factor was hypertension. The EKG showed sinus bradycardia with LVH and CK-MB was slightly elevated as high as 5.4ng/mL. The echocardiography showed normal left ventricular function (EF=60%) with akinesia of inferoposterior wall.

Baseline Coronary Angiography

The left coronary angiography showed diffuse 80% stenosis of LM to mLAD, diffuse 90% stenosis of Di, and diffuse 80% stenosis of pLCX. ( Movie 1, Movie 2)

Procedure

An 8 Fr long-sheath was inserted through right femoral artery because of tortousity, and a 5 Fr sheath was inserted at left femoral artery for the provisional IABP implantation. The left coronary ostium was engaged with an 8 Fr XB 3.5 catheter. A 0.014” BMW wire was inserted into the LAD, a 0.014” soft wire to the LCX and another 0.014” soft wire to the Di. IVUS showed the heavily calcified plaque in the pLCX and the LM to pLAD. We pre-dilated at LAD using a IKAZUCHI 2.5 X 20mm balloon and deployed a PROMUS Element 3.0 X 24mm stent (Figure 1). It was hard to pass the stent to pLCX because of heavy calcifications. So we pre-dilated pLCX using the IKAZUCHI 2.5 X 20mm and Quantum 3.0 X 15mm balloon ( Movie 3). Then the soft wire was reinserted from Di to OM branch and another new 0.014” BMW wire was inserted into the LCX. A PROMUS Element 3.0 X 28 mm Stent was successfully deployed at pLCX (Figure 2) and we performed crushing with a PROMUS 3.5 x 28 mm at dLM to pLAD (Figure 3). Additional kissing ballooning was performed by using a SAPPHIRE NC 3.5 X 15mm at LM-pLAD and a Dura Star 3.0 X 15mm at pLCX (Figure 4). Final left angiogram and IVUS showed that the procedure was successful ( Movie 4, Movie 5).