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 58-year old gentleman admitted our hospital due to effort related chest pain. His coronary risk factors were hypertension and hyperlipidemia. The echocardiography showed normal left ventricular function (EF=66%) without regional wall motion abnormality. |
| Baseline coronary angiography |
The left coronary angiogram showed diffuse narrowing of proximal to mid LAD and tubular narrowing of proximal & distal LCX ( Movie 1, Movie 2, Movie 3, Movie 4). The right coronary was normal ( Movie 5). |
| Procedure |
| An 8 Fr JL 4.0 guiding catheter was engaged into the left coronary artery ostium. Two 0.014 BMW wires were inserted into the LAD and LCX, respectively (Figure 1). Predilatation for lesion modification was done using a Elect 2.5 x 20mm balloon at LCX. Predilatation for proximal LAD stenosis was performed using Sequent 3.0 x 20mm balloon (Figure 2). The distal LMCA bifurcation lesion was treated by a mini-Crushing technique. We sequentially deployed a Resolute integrity stent 3.0 x 38mm at the mid to distal LAD (Figure 3) and a Resolute integrity stent 3.0 x 38mm at the proximal to distal LCX (Figure 4). And then, we implanted another Resolute integrity stent 4.0 x 22mm at the distal LM to proximal LAD. After removal of LCX wire, a 0.014 Choice PT wire was reinserted into LCX. Thereafter, a Sprinter legend 1.5 x 12 and a Elect 2.5 x 20 was sequentially dilated at LCX. After dilatation with a Sequent 3.0 x 20 at proximal to mid LAD and a Dura Star 3.0 x 20 at pLCX, final kissing balloon dilation was performed with a Nimbus Salvo 3.5 x 17mm in proximal LAD to LM and a Sequent 3.0 x 20mm in pLCX to LM (Figure 5). Final angiogram showed well-expanded and well-positioned stents ( Movie 6, Movie 7, Movie 8). |
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