Slides

Treatment of LMCA Bifurcation Using Crushing Technique

- Operator : Seung-Jung Park

Treatment of LMCA Bifurcation Using Crushing Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 70-year old gentleman presented with dyspnea on exertion (NYHA II-III). His coronary risk factors were diabetes, hypertension and smoking and a history of cerebral infarction. The echocardiography showed ischemic insult of LAD and LCX territory with moderate LV dysfunction (EF=40%).
Baseline coronary angiography
Left coronary angiogram showed severe stenosis with ulceration of distal LM bifurcation and intermediate stenosis at mid LAD ( Movie 1, Movie 2, Movie 3). Right coronary was near normal ( Movie 4).
Procedure
An 8 Fr JL 4.0 guiding catheter was engaged into the left coronary artery ostium. 0.014 BMW and soft wire were inserted into the LAD and LCX, respectively. Predilatation for lesion modification was performed at distal LM to proximal LAD using a Maverick 2.5 x 20mm and at proximal LCX using a Sprinter legend 3.0 x 20mm balloon (Figure 1, Figure 2). The distal LMCA bifurcation lesion was treated by a Crushing technique. We sequentially deployed a Xience Prime 3.5 x 23mm stent at the proximal LCX and a Xience Prime 3.5 x 38mm stent at the LM to proximal LAD (Figure 3, Figure 4). A 0.014 Choice PT wire was reinserted into LCX and a Sprinter legend 1.25 x 15mm balloon was passed through the crushed LCX ostium with the anchor balloon technique at proximal LAD stent. Thereafter, a Sprinter legend 1.25 x 15mm, a Maverick 2.5 x 20mm and a NC TREK 3.5 x 15mm balloon were sequentially dilated at LCX (Figure 5). After dilatation with a Dura Star 3.5 x 20mm balloon at the LM to proximal LAD (Figure 6), final kissing balloon dilation was performed with a Dura Star 3.5 x 20mm in proximal LAD to LM and a NC TREK 3.5 x 15mm in proximal LCX to LM (Figure 7). Final angiogram showed well-expanded and well-positioned stents ( Movie 5, Movie 6, Movie 7).

Comments

  • Arash Gholoobi 2012-09-15 TAP would be easier.
  • Sajjad Hussain 2012-09-17 Great case. i wish my center would do more distal LM instead of sending cases to surgeon.
  • Ayhan Olcay 2012-09-17 Dr Park very good case again. But what is your opinion about TAP stenting. Could most of the crush stent cases be done with TAP and have less metal in LMCA.
  • Vijay Kumar Puri 2012-09-23 did you do Ivus in the end

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