Slides
Treatment of distal LMCA Bifurcation Stenosis Using Crushing Technique
- Operator : Seung-Jung Park
| Treatment of distal LMCA Bifurcation Stenosis Using Crushing Technique |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| This 50-year old gentleman admitted our hospital due to effort related chest pain. His coronary risk factors were hyperlipidemia and smoking. The echocardiography showed normal left ventricular function (EF=63%) without regional wall motion abnormality. |
| Baseline Coronary Angiography |
The left coronary angiogram showed tight narrowing of dLM bifurcation and intermediate stenosis at mLAD ( Movie 1, Movie 2, Movie 3). The right coronary was normal. |
| Procedure |
| An 8 Fr JL 4.0 guiding catheter was engaged into the left coronary ostium. Two 0.014 BMW wires were inserted into the LAD and LCX, respectively (Figure 1). Predilatation for lesion modification was done using a Black Hawk 2.5 x 20mm balloon at LAD. The distal LMCA bifurcation lesion was treated by a Crushing technique. We sequentially deployed a Resolute integrity stent 3.0 x 22mm at the pLCX (Figure 2) and a Resolute integrity stent 3.5 x 30mm at the LM to pLAD (Figure 3). After removal of LCX wire, 0.014 Choice PT wire was reinserted into LCX. Thereafter, Sprinter legend 1.25 x 15 and Maverick 1.5 x 20 was sequentially dilated at LCX ostium. After dilatation with Dura Star 3.5 x 20 at pLAD and Dura Star 3.0 x 20 at pLCX (Figure 4, Figure 5), final kissing balloon dilation was performed with a Fortis 3.5 x 20mm in pLAD to LM and a Dura Star 3.0 x 20mm in pLCX to LM (Figure 6, Figure 7). Thereafter, to assess the functional significance of mLAD intermediate lesion ( Movie 4), FFR was measured and showed 0.68. Accordingly, Resolute integrity stent 3.0 x 22 was implanted overlapping with LM to pLAD stent (Figure 8). Final angiogram showed well-expanded and well-positioned stents ( Movie 5, Movie 6, Movie 7). |
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